Ref MTEMPLATESNormal

Application Criteria for a Training Provider Licence Apply Fatigue Management Strategies Address each of the criteria listed below and attach all evidence to support statements related to the criteria. Criteria to become a Provider     Certificate IV in Assessment and Workplace Training; Personal experience in working shifts; Occupational health knowledge and practical experience with same*; Working knowledge of human physiology, psychology and sociology fundamentals. Licensing of Providers Intending providers will be required to: 1. 2. 3. study the course content; attend a one-day familiarisation program (the fee for this course will be $300 plus GST); meet the standards required by an Accreditation Panel. The course is not industry specific and is expected to eventually attract interest from industries other than the mining sector. Course Delivery $150 per capita. Flexibility will enable licensed providers to negotiate with corporations. Maximum Participants per Course 20 MARCSTA - Apply Fatigue Management Provider Licence Application Form: To: Subject: MARCSTA Fax: (08) 9355 1499 Apply Fatigue Management Strategies (Extended Working Hours and Your Health and Safety) Please accept this as application to deliver the above course as a licensed MARCSTA provider: Name: ____________________________________________________________________ _______ Position: ____________________________________________________________________ _______ Organisation: ____________________________________________________________________ _______ ____________________________________________________________________ _______ Postal Address: ____________________________________________________________________ _ __________________________________________________________________________ ________ Telephone: _______________________________Mobile _______________________________ Facsimile: _______________________Email: ________________________________________ ABN: ___________________________________________________________ MARCSTA - Apply Fatigue Management Are you licensed to provider any other MARCSTA programs? If so please detail: __________________________________________________________________________ ________ __________________________________________________________________________ ________ Please return to: Suite 5, Petroleum House, 12 Brodie-Hall Drive, Technology Park, Bentley WA 6102 Tel: (08) 9355 1400 Fax: (08) 9355 1499 Email: safety@marcsta.com Website: www.marcsta.com MARCSTA - Apply Fatigue Management

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