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Work Health and Safety Act 2011 (WHS Act) –
Work Health and Safety Regulation 2017 (WHS Regulation)

EVIDENCE OF IDENTITY AND RECORD OF TRAINING FOR GENERAL CONSTRUCTION INDUCTION TRAINING UNDER THE WORK HEALTH AND SAFETY REGULATION 2017

CIC-EOI/ROT-2 NOVEMBER 2017

Instructions
SafeWork NSW enters into agreements with Registered Training Organisations (RTOs) to deliver general construction induction training (GIT) in NSW under the WHS Regulation. RTOs are required to complete a 100 point evidence of identity (EOI) check for each participant immediately prior to commencing training.

The applicant is required to show the RTO delegate original EOI documents that add up to at least 100 points. Within these documents the applicant must be able to show a photo, date of birth (minimum age 14 years), signature and current residential address. It is the RTO’s responsibility to ensure that the relevant sections of the EOI form are complete, and to verify the EOI documentation provided.

Note: For inmates of a correctional centre an arrangement exists between SafeWork NSW and Corrective Services NSW to assist inmates in obtaining at least 100 points by accepting two additional forms of EOI. These are listed at the bottom of the EOI table in section 1.

Other exceptions to the standard EOI requirements are covered by the special arrangements section of this form. Where special arrangements apply, the standard EOI table is not required to be completed, instead section 2 of this form should be filled out.

The record of training (ROT) (last page of this form) is to be completed by applicants who have successfully completed GIT and provides the information required for the RTO to lodge an application for a GIT card on behalf of the applicant. This EOI/ROT form is to be retained by the RTO and may be called upon for review during an audit or in response to a complaint or compliance related issues.

It is an offence under the Crimes Act 1900 (Crimes Act) and WHS Act to make false or misleading statements on this form, heavy penalties apply.

Privacy compliance statement
Information that you voluntarily provide in this form is collected and retained by the RTO for the purpose of conducting GIT and, if deemed competent, making an application to SafeWork NSW on your behalf.

SafeWork NSW intends to use and disclose the information (including any personal information) you have provided in the following ways:

to exercise its functions under the Work Health and Safety Act 2011, including to administer, monitor and enforce compliance with that Act
to record your information on a licence register, parts of which will be published online
to disclose your information to other state, territory and the Commonwealth regulatory authorities
to educate about work health and safety and contribute to external research about work health and safety
as otherwise required or permitted by law, including for the purpose of prosecution.

SafeWork NSW has a Privacy Management Plan which provides more detailed information about who SafeWork NSW is, how to contact SafeWork NSW, and how SafeWork NSW manages personal and health information in line with NSW privacy laws. A copy of the Privacy Management Plan is available at www.safework.nsw.gov.au.

The Privacy Management Plan provides detailed information about how you may access or amend personal information held about you by SafeWork NSW

SECTION 1. EOI TABLE

This section must be completed prior to the commencement of training. Mark the appropriate boxes

Applicant name*

Please complete the applicable evidence of identity details in the shaded box below (please print in BLOCK LETTERS only)

Primary (only use one primary document)Points value

Australian Birth Certificate/card (minimum 14 years) issued by the Registrar of Births Deaths and Marriages

Number

State

Australian or international passport (current or expired within last two years, but not cancelled)

Number

Country

Australian citizenship certificate

Number

Secondary

Current Australian state or territory driver’s licence or learner driver licence/permit

Number

State

Current Australian state or territory boat operators photo licence (eg personal watercraft driving licence)

Number

State

Current NSW firearms photo licence

Number

Current Australian issued high risk work licence

Number

State

Current Australian state/territory proof of age or photo card (eg a NSW RMS issued photo card)

Number

State

Australian Police or Dept of Defence card (with photo)

Number

The following documents are worth 25 points (please tick box for type of EOI being used and record points value)

The following documents are worth 25 points

Note: If using credit/savings cards or statements (up to a maximum of 2), these must be from different financial institutions. 1 credit/savings card or statement equates to 25 points, 2 equals 50 points.

Total points

Training in a correctional facility

For inmates of a correctional centre an arrangement exists between SafeWork NSW and Corrective Services NSW to accept additional forms of EOI as listed below. This additional EOI applies to correctional centre inmates who are being trained in a correctional facility under this arrangement ONLY.

Correctional centre inmate MIN photo card

Letter of verification from the Department of Corrective Services

Correctional centre inmate MIN card

Correctional centre name and location

(Correctional centre use only) Total points

RTO/NOMINATED TRAINER USE ONLY

Please confirm at least 100 points of EOI containing the following information has been validated by ticking the box below:

Photo ID sighted

Date of birth sighted (applicant is over 14 years)

Current residential address sighted

Signature sighted

SECTION 2. EOI SPECIAL ARRANGEMENTS

This section is only to be completed prior to the commencement of training if special arrangements are utilised.

Special arrangements apply for participants in the following groups:

Aboriginal and Torres Strait Islanders (part A).
School sector (part B).
Overseas persons recently arrived in Australia (for less than six weeks) (part C).

In addition, special exception to the EOI requirements may apply to ‘persons at risk’. Such exception will be dealt with on a case-by-case basis by contacting SafeWork NSW on 13 10 50.

All EOI documentation provided under special arrangements must be original. The RTO must ensure the appropriate part is filled out and that the participant details and declarations in Section 3 of this form are completed.

Applicant name

PART A – ABORIGINAL AND TORRES STRAIT ISLANDERS (points system does not apply)

Authorised referees for Aboriginal and Torres Strait Islanders include:

Chairperson, secretary or CEO of an incorporated Indigenous organisation (including land councils, community councils, housing organisations etc).
Community development employment projects coordinator.
School principal.
School counsellor.
Minister of religion.
Treating health professional or manager in Aboriginal medical services.
Centrelink staff, Centrelink agent or other government employee of at least five years.

Please attach two written statements on organisational/company letterhead verifying the person’s identification:

Name of referee (1)

Organisation

Contact number

Name of referee (2)

Organisation

Contact number

PART B – SECONDARY SCHOOL SECTOR – EOI DOCUMENTATION (points system does not apply)

The identity of the student has been verified by sighting any one of the original documents listed below:

Australian Birth Certificate/card (minimum 14 years) issued by the Registrar of Births Deaths and Marriages

Number

State

Australian Citizenship Certificate

Number

Current Australian driver’s licence or learner driver’s licence

Number

State

International travel documents including a current passport or a passport which has expired within the last two years, but has not been cancelled. Please state type of travel document (for example – where a passport is used, include passport number and the country of issue and check the expiry date).

OR

The identity of the student has been verified by sighting a written statement on school letterhead confirming the student’s name and date of birth.

Name of school and location

Name and title of school official

Date of statement (DD/MM/YYYY)

OR

The identity of the student has been verified by sighting a student ID card that contains the school crest/seal, photo, student’s name and date of birth.

PART B – SECONDARY SCHOOL SECTOR – EOI DOCUMENTATION (points system does not apply)

PART C – OVERSEAS PERSONS RECENTLY ARRIVED IN AUSTRALIA LESS THAN SIX WEEKS (points system does not apply)

Only use this section when the person has been in Australia for less than six weeks and is not ordinarily a resident of Australia.

1. The identity of the person has been verified by sighting one of the following overseas travel documents.

Passport number

Expiry date (DD/MM/YYYY)

Country

Date of arrival (DD/MM/YYYY)

OR

Other international documents of identity that have the same characteristics as a passport for example – diplomatic documents and documents issued to refugees.

Document type and number

AND

2. One of the following EOI documents (Australian or overseas). Please tick the appropriate box.

Current driver’s licence

Number

Country

Credit/Savings account card

Name of institution

Expiry date (DD/MM/YYYY)

SECTION 3. PARTICIPANT DETAILS AND DECLARATION

This section is to be completed prior to the commencement of training

Title

Family/Surname

Date of birth (DD/MM/YYYY)

Given name

Mobile number

Other names

Email*

STREET ADDRESS (MUST NOT BE A PO BOX)

Unit number/Street number/Property number (include Lot or DP number if applicable)

Street name

Suburb

State

Postcode

POSTAL ADDRESS

Unit number/Street number/Property number (include Lot or DP/PO Box/GPO Box/Private Bag/Locked Bag)

Same as street address

Street name

Suburb

State

Postcode

PARTICIPANT DECLARATION

I declare that the details contained on this form are true and correct. The EOI details were provided to the RTO prior to attending GIT under the WHS Regulation.

Participant’s signature

Date (DD/MM/YYYY)

It is an offence under the Crimes Act 1900 (Crimes Act) and WHS Regulation to make false or misleading statements in this application.

SECTION 4. RTO AND NOMINATED TRAINER DETAILS AND DECLARATION

This section is to be completed prior to the commencement of training.

RTO name

Nominated trainer name

SafeWork NSW approval number

Nominated trainer identification

RTO DELEGATE DECLARATION

I certify that I have sighted and confirmed the participant’s EOI against original documentation provided prior to conducting GIT under the WHS Regulation.

RTO delegate’s signature

Date (DD/MM/YYYY)

It is an offence under the Crimes Act and WHS Regulation to make false or misleading statements in this application.

EOI

EVIDENCE OF IDENTITY AND RECORD OF TRAINING FOR GENERAL CONSTRUCTION INDUCTION TRAINING UNDER THE WORK HEALTH AND SAFETY REGULATION 2017

CIC-EOI/ROT-2 NOVEMBER 2017

SECTION 1. EOI TABLE

SECTION 2. EOI SPECIAL ARRANGEMENTS

PART A – ABORIGINAL AND TORRES STRAIT ISLANDERS (points system does not apply)

PART B – SECONDARY SCHOOL SECTOR – EOI DOCUMENTATION (points system does not apply)

OR

OR

PART C – OVERSEAS PERSONS RECENTLY ARRIVED IN AUSTRALIA LESS THAN SIX WEEKS (points system does not apply)

OR

AND

SECTION 3. PARTICIPANT DETAILS AND DECLARATION

PARTICIPANT DECLARATION

SECTION 4. RTO AND NOMINATED TRAINER DETAILS AND DECLARATION

RTO DELEGATE DECLARATION

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