MARITIME INDUCTION / REINDUCTION AUTHORISATION FORM

Return fax: 4976 2309
Return email: [email protected]
QUEENSLAND ALUMINA LIMITED
A.C.N. 009 725 044
MARITIME INDUCTION / REINDUCTION AUTHORISATION FORM
COMPANY:
COMPANY MGT. CONTACT PERSON
TELEPHONE #:
Work Engaged in at QAL Wharf Facility Site (Describe):
θ Re-Induction
θ New Induction
(has current or near current QAL Access Badge)
θ Change / Delete
• This form is to be completed by the Company Supervisor and be submitted to the Shipping Team before attendees can access the online
induction / re-induction.
• QAL Site Pass always remains the property of QAL and must be returned to Security when no longer required.
Surname
Given Names
Job Classification
In Full & Preferred Name, ie, William Daniel (Bill)
(e.g. Electrician, Engineer)
MSIC CARD NUMBER:
EXPIRY DATE:
MSIC CARD NUMBER:
EXPIRY DATE:
MSIC CARD NUMBER:
EXPIRY DATE:
MSIC CARD NUMBER:
EXPIRY DATE:
COMPANY SUPERVISOR NOMINATING EMPLOYEE FOR WHARF ACCESS:
Date of Birth
QAL Bdg. #
if applicable
EMAIL
ADDRESS
An email address
must be supplied
_____________________________________ _________________________________ _____________
Signature
Print Name
Date
TELEPHONE #: ______________________________
QAL SUPERINTENDENT SHIPPING APPROVING
INDUCTION / RE-INDUCTION / WHARF ACCESS:
S-XXX-XXXX
_____________________________________ _________________________________ _____________
Signature
Print Name
Date