Assignment Paper

Workplace Safety and Health Officer Application
Professional Work Review Write-up
There are a total of seven sections in this assessment form.
It may take you around 2 hours to give a comprehensive submission.
Please complete the template, sign, scan (200dpi resolution and greyscale) and save it in PDF format for submission.
(DO NOT attach/insert any photographs or pictures.
Do not amend or modify the fields/table format. Indicate requested details only)
SECTION A: PERSONAL INFORMATION & EMPLOYMENT DETAILS
Name NRIC/FIN
Company Name
Industry Type
Nature of business
Designation
Employment period
~ Do not amend or modify the fields/table format. Indicate requested details only

SECTION B: ACADEMIC QUALIFICATION (NON-WSH RELATED)
Highest (Non-WSH) Academic Qualification
Name of Awarding Institution
Country of Awarding Institution
Year of Completion
~ Do not amend or modify the fields/table format. Indicate requested details only

SECTION C: APPROVED QUALIFICATION FOR WSH Officer Registration
Qualification (do not add any other qualification to this list) Year of Completion Tick at least one option
Specialist Diploma in WSH, awarded by SkillsFuture Singapore
Master of Science in Safety, Health and Environment Technology, awarded by the National University of Singapore
Bachelor of Environment Occupational Health and Safety, awarded by the University of Newcastle (Australia)
Bachelor of Science in Human Factors in Safety, awarded by the Singapore University of Social Science (formerly SIM University)
Bachelor of Science (Health, Safety and Environment), awarded by the Curtin University of Technology (Singapore Campus)
Bachelor of Science (Hons) Safety, Health and Environmental Management, awarded by Leeds Beckett University (Singapore Campus), from September 2015
~ Do not amend or modify the fields/table format. Indicate requested details only

SECTION D: OTHER WSH QUALIFICATIONS
Qualification Awarding Institution Year of Completion
Advanced Certificate in Workplace Safety and Health
Safety Coordinator Training Course
Develop a Risk Management Implementation Plan (bizSAFE Level 2) Course / Risk Management Course
Develop a WSH Management System Implementation Plan (bizSAFE Level 4) Course
~ Do not amend or modify the fields/table format. Indicate requested details only

SECTION E: DEMONSTRATION OF WSH EXPERIENCE
You may need around 60 minutes to complete this Section. Each response should be limited to 500 words or less.
(i) Please describe the WSH legislative requirements that are most relevant to your field of work and how they have been complied with in your workplace.
[You should demonstrate your knowledge of WSH legislative requirements relevant to your field of work by citing examples of WSH regulations and how they are applied.] (a) WSH Act
• Cite a Section No. of the WSH Act (e.g. Section No. 12) that is relevant to your area of work and describe what that law requires.
• Give an on-site application on how your workplace complies with this Section of the Act.
(Do not copy and paste the legislation)

 Section No.:
 Explain what the selected Section No. relates to (in your own words):

 Describe application (in bullet points):
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(b) WSH (Risk Management) Regulations
 Cite a Risk Management Regulation (e.g. Regulation No. 3(1)) that is relevant to your area of work and describe what the legislation requires.
 Give an on-site application on how your workplace complies with this Regulation.
(Do not copy and paste the legislation)

 Regulation No.:
 Explain what the selected Regulation No. relates to (in your own words):

 Describe application (in bullet points):
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(c) WSH (Incident Reporting) Regulations
 Cite an Incident Reporting Regulation (e.g. Regulation No. 4(1)) and describe what it requires.
 Give an on-site application on how your workplace complies with this Regulation.
(Do not copy and paste the legislation)

 Regulation No.:
 Explain what the selected Regulation No. relates to (in your own words):

 Describe application (in bullet points):
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
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(d) WSH (General Provisions) Regulations
 Cite a General Provisions Regulation (e.g. Regulation No. 23(1)) and describe what it requires.
 Give an on-site application on how your workplace complies with this Regulation.
(Do not copy and paste the legislation)

 Regulation No.:
 Explain what the selected Regulation No. relates to (in your own words):

 Describe application (in bullet points):
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(e) Any other WSH legislation of your choice [excluding (a) to (d)] (indicate title):
 Cite any Regulation (state regulation number) and describe what it requires.
 Give an on-site application on how your workplace complies with this Regulation.
(Do not copy and paste the legislation)

 Regulation No.:
 Explain what the selected Regulation No. relates to (in your own words):

 Describe application (in bullet points):
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
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 
(f) Any other WSH legislation of your choice [excluding (a) to (e)] (indicate title):
 Cite any Regulation (state regulation number) and describe what it requires.
 Give an on-site application on how your workplace complies with this Regulation.
(Do not copy and paste the legislation)

 Regulation No.:
 Explain what the selected Regulation No. relates to (in your own words):

 Describe application (in bullet points):


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 
(ii) Please describe one WSH workplace hazard which you had identified and addressed.
[You should demonstrate your practical experience in applying risk management concepts, risk assessment process, risk matrix, and hierarchy of controls with examples.]

(a) Title of workplace hazard identified at your workplace:

(b) Type of risk matrix used (please specify 3 by 3; 5 by 5; or others):

(c) Evaluation of initial risk assessment using risk matrix (before hierarchy of control): Severity X Likelihood:
(To show calculation and indicate level of the risk)

(d) Application of Hierarchy of Control:

 Elimination (in bullet points below the heading)
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
 Substitution (in bullet points below the heading)
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 Engineering Control (in bullet points below the heading)
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 Administrative Control (in bullet points below the heading)
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 Personal Protective Equipment [PPE] (in bullet points below the heading)
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

(e) Evaluation of final risk assessment using risk matrix (after hierarchy of control): Severity X Likelihood:
(To show calculation and indicate level of the risk)

(f) Follow-up action (indicate the list of actions taken in bullet points):
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(iii) Please describe one workplace accident/incident you have encountered and how you identified and addressed the root cause of the accident/incident.
[You should demonstrate your practical experience in accident/incident investigation and your role in the investigation team, including explanations of the investigation methodology used and outcomes derived from the investigation.]

(a) Title of incident/accident (e.g. hit by falling object):

(b) Description of incident/accident:
 Date:
 Time:
 Location:
 Summary of the incident/accident (in bullet points):
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 Actions taken to preserve the scene of incident/accident (in bullet points):
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(c) Title of Methodology used to identify root cause:

(d) Show diagram:

(e) Explain how the diagram was used to identify the root cause (in your own words):

(f) Root cause(s) identified (in bullet points):
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

(g) Immediate Corrective and Preventive actions taken (in bullet points):
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(h) Follow-up action to prevent future occurrence (in bullet points):
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(iv) Please describe your experience in setting up and implementing a WSH Management System (WSHMS) including the challenges faced and how you overcame the challenges.
[You should demonstrate practical experience and understanding in developing or implementing a WSH Management System.]

a) Title of WSHMS:

b) List down all the Elements in the WSHMS stated in (a) (indicate the list in bullet points):
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c) Choose 3 elements from (b) that is currently used in your company and describe the details below:

i. Element 1 [physical/practical type that requires on-site involvement]

 Element Title:

 What are the challenges encountered (indicate the list of challenges in bullet points)?

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

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

 What are the solutions you have taken to overcome the challenges (indicate the list of solutions in bullet points)?
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

ii. Element 2 [physical/practical type that requires on-site involvement]

 Element Title:

 What are the challenges encountered (indicate the list of challenges in bullet points)?
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
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

 What are the solutions you have taken to overcome the challenges (indicate the list of solutions in bullet points)?
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iii. Element 3 [administrative/paperwork type]

 Element Title:

 What are the challenges encountered (indicate the list of challenges in bullet points)?
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 What are the solutions you have taken to overcome the challenges (indicate the list of solutions in bullet points)?
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 

SECTION F: WSH EXPERIENCE RELEVANT TO WORK TO BE PERFORMED BY A WSHO
Please complete the following table as accurately as possible.
A B C D E F G
Date of Employment Company Designation and Contract Title
(if applicable) Job scope
Duration of Employment Extent of WSH Contribution Months of WSH Contribution
[(F/100) X E] Example:
1/1/2008
To
31/12/2008
AAA (S) PTE LTD
Clerk of Works cum WSH Coordinator
Condominium Project at Lorong BBBB
WSH Roles
1) Site Inspection
2) Accident Investigation
3) Safety Committee Member
4) Toolbox Meeting
5) ETC

Non-WSH Roles
1) Assist Project Manager to monitor work progress
2) ETC
12 months
50%
(50/100) x 12
= 6 months

Total Employment Duration __________ months
Total Duration of WSH Experience __________ months
~ Do not amend or modify the fields/table format. Indicate requested details only

SECTION G: DECLARATION

I, _________________________________ holder of _________________ (NRIC/FIN/Work Pass No.) hereby declare that the information contained in this professional review write-up is true and correct to the best of my knowledge. I am also aware that:
a) my application will be rejected if my application is incomplete and/or if there are missing supporting documents including the work review write-up.
b) my application will be rejected if any information provided was misrepresented, and that legal actions may be taken against me if I had knowingly provided any false information.
c) I have to fulfil the terms and conditions of the application (as stated on MOM website).
d) my application will be evaluated by the Commissioner for Workplace Safety and Health based on the required qualifications, work experience (verified through employer testimonial) and the quality of the work review write-up submitted herein.

__________________________________

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Name Signature Date