Workplace Health and Safety Queensland
Form 105
Application to become an approved trainer
to deliver Work Health and Safety Officer (WHSO) course
V15.04.19
Work Health and Safety Act 2011
Background
The requirement of a Work Health and Safety Officer (WHSO) to undertake a course of training is outlined in the Work Health and Safety Act
2011 (WHS Act). The WHS Act provides the WHSO training must be provided through a course of training that is approved by Workplace Health
and Safety Queensland (WHSQ).
The terms and conditions on which the Regulator for work health and safety in Queensland agrees to grant authority to the registered training
organisation (RTO) to provide WHSO training and assessment in Queensland is set out in the Conditions of agreement as an authorised RTO of
Work Health and Safety Officer (WHSO) course (the Conditions).
To help you in completing this form, please refer to the Conditions of agreement as an authorised RTO of Work Health and Safety Officer (WHSO)
training. If you require further information please call 1300 362 128.
Guide for applicants
Work health and safety qualification
To become an approved trainer to deliver the WHSO course, you are required to hold a minimum Certificate IV in Work Health and Safety or
Diploma of Work Health and Safety. Equivalent or higher level qualifications may be accepted, where the units of competency can be mapped
to Certificate IV or Diploma of Work Health and Safety and demonstrate the equivalent or higher level of acquired knowledge. Qualifications of
this nature would need to be submitted to WHSQ for consideration.
Adult education qualification
To become a trainer to deliver the WHSO course, you are required to hold an adult education credentialing consistent with Appendix 3 of the
Conditions, as follows:
Date Training and assessment credentials
Prior to 1 April 2019 One of the following credentials:
TAE40110 Certificate IV in Training and Assessment OR
Credential: TAE40116 Certificate IV in Training and Assessment or its successor OR
A diploma or higher level qualification in adult education.
From 1 April 2019
One of the following credentials:
TAE40116 Certificate IV in Training and Assessment or its successor OR
Credential: TAE40110 Certificate IV in Training and Assessment, and one of the following:
TAELLN411 Address adult language, literacy and numeracy skills or its successor OR
TAELLN401A Address adult language, literacy and numeracy skills
and one of the following:
TAEASS502 Design and develop assessment tools or its successor OR
TAEASS502A Design and develop assessment tools OR
TAEASS502B Design and develop assessment tools OR
A diploma or higher level qualification in adult education.
Evidence of relevant experience
To become a trainer to deliver the WHSO course, you are required to provide a minimum of two years relevant experience in an occupational or
work health and safety role. This could be demonstrated by:
•
A reference letter provided by an employer, on company letterhead, stating the dates of employment and the nature of the role.
•
Job description/letter of engagement from employer.
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Form 105 - Application to become an approved trainer to deliver Work Health and Safety Officer (WHSO) course ABN 94 496 188 983
1. Applicant details
Title Mr Ms Mrs Miss Mx Surname
First name Second name
(If applicable)
Date of birth
Residential address (Must be an Australian street address and not a PO Box)
State
Postcode
Unit number, Street number, Street name, Suburb/locality
Telephone Mobile
Email (mandatory)
Postal address (Must be an Australian PO Box address)
Please tick this box if the postal address is the same as the address above.
State
Postcode
PO Box | GPO Box | Private Bag Locked bag number, Suburb/locality
D D M M Y Y Y Y
2. RTO details
Name of RTO
Name of contact person
First name
Surname
Physical address
State
Postcode
Unit number, Street number, Street name, Suburb/locality
Telephone
Email (mandatory)
Postal address
Please tick this box if the postal address is the same as the address above.
State
Postcode
PO Box | GPO Box | Private Bag Locked bag number, Suburb/locality
3. Qualifications
Please specify below the details of the Work Health and Safety and Adult Education qualification you have submitted copies of.
Qualification Date statement of
attainment was issued
RTO
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Form 105 - Application to become an approved trainer to deliver Work Health and Safety Officer (WHSO) course ABN 94 496 188 983
Privacy statement
The Queensland Government is collecting your personal information in order to process your application to become an approved trainer to deliver Work Health
and Safety Officer (WHSO) course in accordance with the Work Health and Safety Act 2011. It is the department’s usual practice to disclose this information to the
applicable Commonwealth, state or territory health and safety regulator/s in order to obtain information relevant to making a decision on your application.
worksafe.qld.gov.au
Workplace Health and Safety Queensland
© State of Queensland 2019. PN12372
1300 362 128
4. Checklist for applying to become a trainer
Please ensure you check the following are included in your application:
1. The Application to become an approved trainer to deliver WHSO course form signed and completed.
2. Scanned and certified copy of Work Health and Safety Qualification;
a) Certificate IV in Work Health and Safety, or
b) Diploma of Work Health and Safety, or
c) Equivalent qualification.
3. Scanned and certified copy of Adult education credentialing consistent with Appendix 3 of the Conditions.
4. Evidence of a minimum of two years relevant experience in an occupational or work health and safety role.
5. A certified and colour copy of photographic identification; drivers licence, passport, or 18+ card.
5. Declaration by applicant
I declare that:
The information supplied in this application is true and correct to the best of my knowledge.
None of the information supplied by me in this application or in any other documents attached to or submitted in support of
this application is false or misleading.
Applicant’s signature
Date of signature
First name
Surname
RTO representative signature
Date of signature
First name
Surname
D D M M Y Y Y Y
D D M M Y Y Y Y
6. Returning the form
Scan and email:
WHStraining@oir.qld.gov.au
Post:
Licensing and Regulatory Interventions
Workplace Health and Safety
Queensland PO Box 820
Lutwyche QLD 4030
Phone:
1300 362 128
AEU19/5166
