Title: Application to Bring Classified Plant onto
SPA Port of Esperance (SPA PoE) Site Form
Document No :
D16/349[v2]
Version:
02
Issue Date:
18/10/2016
Page:
1 of 1
Notice: This form is to be filled out when bringing classified plant onto the SPA PoE site (Part 6 section
6.34 (5) of the Mines Safety and Inspection Regulations 1995)
Send Application and all required details through to [email protected]
Where practical please allow for a minimum of 5 working days prior to plant arriving on site.
Filed:
Maintenance Planner
Section 1: Company / Person Details
Company
Address
Contact name
Contact Number
Phone
Mobile
Date equipment due on site
Expected departure date
Section 2: Classified Plant Details
Type of Equipment
Crane
EWP
Pressure vessel
Others Please Specify
Model
Make
Serial Number
Plant Registration Number
Date of last Inspection
Re-inspection Date
Section 3: Previous History
Has the above Plant been used on the SPA PoE site in the last 12 weeks
YES
If Yes
Email through this Application with a copy of Item 1 below to
[email protected]
If No
Email through this Application along with a copy of all 3 items listed below to
[email protected]
NO
Item
1
Current Certificate of Inspection
2
Evidence of Plant Registration
3
Certificate of Plant Design
Section 4: Sign off
Acknowledgement that all information supplied with this Application is correct and that the plant coming to
SPA PoE site is safe to use and in good working order
Signature:
Position:
Name:
Date:
/
/
CONTROLLED DOCUMENT WHEN PRINTED RED
File:81899667
This copy printed:31/07/17 21:10