Workplace Safety and Health Officer Application
Professional Work Review Write-up
Please complete the following template, sign, scan, and save it as a PDF format for submission.
SECTION A: PERSONAL INFORMATION
Name
Academic Qualifications
Highest Academic Qualification
Name of Awarding Institution
Country of Awarding Institution
Year of Completion
WSH Qualifications (Please tick the relevant qualifications and furnish details accordingly)
Qualification
Awarding Institution
Year of Completion
Specialist Diploma in WSH awarded
by WDA’s accredited Training Centre
Recognised equivalent to Specialist
Diploma in WSH:
Advanced Certificate in WSH
awarded by WDA’s accredited
Training Centre
Other WSH qualifications:
SECTION B: CURRENT COMPANY PROFILE AND ROLE
Please briefly describe in no more than 500 words your current company profile/nature of business and
your current role.
Professional Work Review Write-up template version 2.0 correct as at 3 July 2013
SECTION C: DEMONSTRATION OF WSH EXPERIENCE
All responses should be limited to no more than 500 words.
(i) Please describe the WSH legislative requirements that are most relevant to your field of work and how
they have been applied/complied in your workplace.
[You should demonstrate knowledge of WSH legislative requirements relevant to your field of work by citing
examples of WSH regulations and how they are applied.]
(ii) Please describe one WSH risk which you had identified and addressed.
[You should demonstrate understanding of risk management concepts, risk assessment process, risk matrix, and
hierarchy of controls with examples.]
Professional Work Review Write-up template version 2.0 correct as at 3 July 2013
(iii) Please describe one workplace accident/incident you have encountered and how you identified and
addressed the root cause of the accident/incident.
[You should demonstrate accident/incident investigation experience and your role in the investigation team,
including explanations of the investigation process, methodology, and outcomes derived from the investigation.]
(iv) Please describe your experience in setting up and implementing a WSH Management System
including the challenges faced and how you overcame the challenges.
[You should demonstrate understanding and experience in at least one WSH Management System.]
Professional Work Review Write-up template version 2.0 correct as at 3 July 2013
SECTION D: RELEVANT WSH EXPERIENCE
Please complete the following table as accurately as possible.
A
Date of
Employment1
B
Company
C
Designation
and Contract
Title
D
Job scope
2
E
F
G
Duration of
Employment3
Extent of
WSH
Contribution4
Months of WSH
Contribution
50%
(50/100) x 12
[(F/100) X E]
(if applicable)
Example:
1/1/2008
To
31/12/2008
AAA (S)
PTE LTD
Site Supervisor
WSH Roles
12 months
Condominium
Project at
Lorong BBBB
1)
Site Inspection
2)
Accident Investigation
3)
Safety Committee Member
4)
Toolbox Meeting
5)
ETC
= 6 months
Non-WSH Roles
1)
Assist Project Manager to monitor work
progress
2)
ETC
Total Employment Duration
__________ months
Total Duration of WSH Experience
__________ months
1
Please indicate start and end date of employment.
Please highlight your job responsibilities for each appointment (both WSH and non-WSH) in point form.
3 Please indicate the total duration of employment by number of months.
4 Please estimate the percentage of time spent in each appointment on WSH related issues only.
2
Professional Work Review Write-up template version 2.0 correct as at 3 July 2013
DECLARATION
I, _________________________________ holder of _________________ (NRIC/FIN/Work Pass No.) hereby declare that the information contained
in this professional review write-up is true and correct to the best of my knowledge. I am aware that my application will be rejected if any information
provided was misrepresented, and that legal actions may be taken against me if I had knowingly provided any false information.
__________________________________
___________________________________
___________________________________
Name
Signature
Date
Professional Work Review Write-up template version 2.0 correct as at 3 July 2013