Operate Safe Registration form.

Our company wishes to register to become an Operate Safe Accredited Contractor. We agree to comply with Operate Safe requirements as set out in the Operate Safe Manual, and to achieve Stages 1, 2 and 3 of the Operate Safe accreditation process as set out on the Minimum Stage Requirements document (click link to access). On receipt of this application, please invoice our company with the $200 (inc. GST) registration fee. In return, on the successful completion of each stage, Operate Safe will issue a certificate confirming that the stage's requirements have been met.

Please complete all details and click on "Send form" at the bottom of this page.

Company name

Contact name

Phone

Fax

E-mail Address

Postal Address

Our company is ACC Accredited	Yes	No

If you answered Yes, what is the level of accreditation?
Primary	Secondary	Tertiary


If you answered No, or you are Primary accredited, are you registered with ACC to become Secondary accredited?
Yes	No


What ACC Scheme are you in, or, you intend to join?
WSMP	Partnership


What is your ACC Number


What is the number and value of your ACC injury claims pre employee?
number of claims:	$/employee:


What is the number and value of your ACC entitlement claims per employee? [claims in respect of sick leave, rehabilitation, lump sum payments, etc.]
number of claims:	$/employee:


How many employees do you have working on roading sites, on manufacturing plants and in depots?
number:


How many of these employees have an Induction Card?
number:


How many more employees need to obtain Induction Cards?
number:

Any other information:

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