Application For Occupational Diving Certificate Of Competency - Worksafe New Zealand
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1
2
3APPLICATION FOR OCCUPATIONAL
DIVING CERTIFICATE OF COMPETENCY
Health and Safety at Work Act 2015 and Health and Safety
Employment Regulations 1995
Before submitting your application, have you:
1. Included your up-to-date Dive Medical Clearance from Diving
8. Included a copy of your qualifications (ADAS, PADI, SSI etc)
Hyperbaric Medicine Services which costs $97.00 payable to the
a. Construction divers your official ADAS card/s or copies
Diving Hyperbaric Medicine Services attained prior to applying
will be accepted (certificates are not acceptable as stated
for your Certificate of Competency Occupational Diving?
on the certificate)
2. Completed all relevant parts and pages in this form?
b. Instructor/Tutors divers include evidence of your current
teaching status
3. Read and understand the requirements of the HSE regulations
1995 and implications of being a holder of certificate of
c. Scientific divers include a letter of authorisation as a
competency?
scientific diver from a recognised scientific organisation
and evidence of specific scientific divers training
4. Ensured that all persons named as referees can confirm the
d. Include evidence of ‘suitable recent training’ relevant
details provided?
to the category/ies applied for.
5. Attached a recent passport-sized photo with your name on the
back or scan and email?
9. Have your Statutory Declaration completed by a duly
authorised person (Justice of the Peace)?
6. Included your current complete and up-to-date dive logbook?
10. Renewals must be lodged prior to the date of expiry.
7. Paid via Direct Credit Payment (print and attach to show proof
of payment) or cheque made out to WorkSafe New Zealand?
11. Application fees are Non Refundable.
Fees
Fee are non-refundable and include GST.
Direct Credit Payment:
Account Name: WorkSafe New Zealand
Initial Application
$92.00
Bank: Westpac Account:
Renewal/Replacement
$57.50
03-0251-0040445-000
Please attach
(Once expired classified as a new
GST Number: 112-953-256
resent photo
application)
or email
Please quote: your name on
(email address
Remittance advice
Please put in your reference or we
on backpage)
Particulars: last name
will be unable to match your payment
Code: First name
with your application which could
cause delays.
Reference: Diving
Please print out receipt of payment
and attach to your application.
1. Details of Applicant
Surname:
Town or city:
First names:
Postcode:
Residential address:
Email:
Telephone number (daytime):
Mobile:
Postal address:
Date of birth:
/
/
DD
MM
YEAR
Are you authorised to work in New Zealand:
Yes
No
WORKSAFE NEW ZEALAND
PO Box 165, Wellington 6140
0800 030 040
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