Application Form To Be Type B Certifier

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Authority No.
(Office Use Only)
APPLICATION TO BE A
TYPE B APPROVING AUTHORITY
Petroleum and Gas (Production and Safety) Act 2004
Form PGA733(2) – Version Number 2
Pursuant to s733(2) the Chief Inspector, Petroleum and Gas may approve a person or a body to
OFFICIAL USE ONLY
approve the offer for sale, installation or use of a gas device or a gas fitting.
PART A
You should complete this form if you want to become an approving authority for Type B gas devices.
Received AT
DATE
Information on this form is being collected to assess your application to be a Type B approving
/
/
authority under the Petroleum and Gas (Production and Safety) Act 2004. Your personal information
will not be disclosed outside the agency without your permission or as required by law.
Received BY
The original completed application and all supporting documentation must be submitted. Please print
clearly in ink and use block letters.
PART B
This form and general information about the approval process (including interview and assessment
RECOMMENDATION
process) can be found at:
devices.htm.
Class S……………..
Class C……………..
For enquiries on Type B approvals, please contact –
Class M……………..
Chief Inspector Petroleum and Gas
Department of Natural Resources and Mines
Restrictions
Mine Safety and Health
PO Box 15216
……………………………………………………………………………………….
City East Qld 4002
Email: gassafe@dnrm.qld.gov.au
………………………………………………………………….………………….
………………………………………………………………….………………….
1.
SECTION 1 ‐ DETAILS OF APPLICANT
Principal Inspector Petroleum & Gas
Full Name of Applicant (or contact if applicant is a company):
PART C
Date Interview held:
Position Title:
Date Test held:
Name of Company (if relevant):
Result:
COMMENTS/RESTRICTIONS
Postal Address:
Business Phone:
……………………………………………………………………………..………….
…………………………………………………………………………….………….
Postcode:
……………………………………………………………………………………….
Home Phone:
Mobile Phone:
APPROVED:
Fax:
Email:
Chief Inspector Petroleum & Gas

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