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    Form A

    Uploaded by

    Musadiq Hussain
    This form provides general information about an entity seeking to develop an Occupational Safety and Health Management System (OSHMS). It includes details such as the entity's name, type of business, number of employees, current OSH resources, and contact information. The entity plans to complete development of its OSHMS by a specified target date. It declares that all information provided is true and correct. Relevant regulatory authorities will review the application and provide an assigned classification code and registration number with a deadline for OSHMS completion.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form A

    Uploaded by

    Musadiq Hussain
    38 views2 pages
    This form provides general information about an entity seeking to develop an Occupational Safety and Health Management System (OSHMS). It includes details such as the entity's name, type of business, number of employees, current OSH resources, and contact information. The entity plans to complete development of its OSHMS by a specified target date. It declares that all information provided is true and correct. Relevant regulatory authorities will review the application and provide an assigned classification code and registration number with a deadline for OSHMS completion.

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    This form provides general information about an entity seeking to develop an Occupational Safety and Health Management System (OSHMS). It includes details such as the entity's name, type of business, number of employees, current OSH resources, and contact information. The entity plans to complete development of its OSHMS by a specified target date. It declares that all information provided is true and correct. Relevant regulatory authorities will review the application and provide an assigned classification code and registration number with a deadline for OSHMS completion.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    38 views2 pages

    Form A

    Uploaded by

    Musadiq Hussain
    This form provides general information about an entity seeking to develop an Occupational Safety and Health Management System (OSHMS). It includes details such as the entity's name, type of business, number of employees, current OSH resources, and contact information. The entity plans to complete development of its OSHMS by a specified target date. It declares that all information provided is true and correct. Relevant regulatory authorities will review the application and provide an assigned classification code and registration number with a deadline for OSHMS completion.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Form A

    General Information

    Name of Entity:

    Type of Business Activities:

     Building and Construction  Education

     Food  Commercial

    Sector Name:  Industry  Tourism & Culture

     Waste  Transport

     Health  Energy

    Number of Employees:

    Advisor / Officer /
    Current OSH Resources: Director / Manager:
    Technical / Other:

    Address: Zone : _______________


    Coordinates: Northing : _______________
    Easting : _______________
    Contact of Head Office within
    Emirate: Telephone No.: E-mail Address:

    Fax No.: P.O. Box:

    Authorized Contact Person:

    Authorized Contact Person


    Position / Title:
    Telephone No.: E-mail Address:
    Contact Details of Authorized
    Person: Fax No. : P.O. Box :

    Coordinates:
    Other Offices / Sites / Projects Address:
    Zone Northing Easting
    Operating Under this Entity
    Operating License:

    Location Map(s):  Location map(s) of Head Office and Branches attached.

    Schedule of Developing & Implementing of OSHMS


    Target Date for Completing the
    Development of OSHMS: ___ ___ (Day) ___ ___ (Month) ___ ___ ___ ___ (Year)

    Occupational Health & Safety Management System (OHSMS)

     Have an OHSMS in place and certified to OHSAS 18001.

     Have an OHSMS in place based on OHSAS 18001 but not certified by third party.

     Have an OHSMS in place but not certified by third party.

     No OHSMS in place.

    OSHAD-SF – Forms
    Form A – Registration for Development of an OSHSM - Version 3.1 – 15th February 2017 Page 1 of 2
    Form A

    Declaration

    I declare that all information provided in this document is true, correct and complete.

    I understand that if I utilize the service of consultants for OSH MS development and/or implementation that they must be
    registered to perform this work in the appropriate category as per OSHAD’s requirements.

    Signature of the
    Official
    Authorised
    Stamp :
    Contact Person:

    Date :
    (DD/MM/YYYY)

    Official Use

    Assigned Classification Code: _____________________________________________________________

    Assigned Registration Number: ____________________________________________________________

    Deadline for completing the development of OSHMS: ___ ___ (Day) ___ ___ (Month) ___ ___ ___ ___ (Year)

    Note: Implementation of the Entity’s OSHMS shall commence within 30 days of receiving approval from the concerned SRA.
    Note: Incident Reporting Requirements shall commence from the date of nomination / notification.
    Note: OSH Performance Reporting Requirements shall commence in the quarter following quarter of approval.
    Note: Annual Third Party External Compliance Audit shall be undertaken with (12) twelve months from the date of approval.

    Relevant Authority Stamp Entered into Database by:

    Name:

    Signature:

    Date: (DD/MM/YYYY) _____ / _____ / _____

    Reviewed by:

    Name:

    Signature:

    Date: (DD/MM/YYYY) _____ / _____ / _____

    OSHAD-SF – Forms
    Form A – Registration for Development of an OSHSM - Version 3.1 – 15th February 2017 Page 2 of 2

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