ASSESSMENT FORM
TEST CERTIFIER
ANNEX B HSNO Legislation
In accordance with s82 of the HSNO Act 1996, regulation 11 (4)(a) of the Personnel Qualifications
Regulations 2001.
Applicant
Assessor
Date
This serves to confirm that I assessed the applicant’s knowledge of the various legislation listed in
the table below on
(date).
Legislation
Method of assessment
Results of assessment
Example: Fireworks Regs
2001
Interviewed – applicant was
given scenarios and required to
navigate through legislation to
provide answers
Competent – applicant can
accurately provide correct answer
to the various scenarios put
forward.
www.worksafe.govt.nz
2
Annex B HSNO Legislation
September 2014
3
Annex B HSNO Legislation
I am confident that the applicant has a satisfactory knowledge of the legislation listed in the table
above and that they have demonstrated that they can meet all legislative requirements in this
regard.
Assessor’s Signature
Assessor’s qualification/designation
Assessor’s knowledge of the legislation was attained by?
Successfully completing HSNO training course? (provided full details)*
Current test certifier?
HSNO enforcement officer?
Other (provide details)
*Course name, course criteria, name of trainer, date of training
September 2014