This form is for you to submit a request for recognition of prior learning. This request will be assessed and one of our co-ordinators will be in touch with you.

1 Step 1
Recognition of prior learning and recognition of current competency
HSRs full name here
Contact Name
NZQA number
Recognition of prior learning
Attendance at Stage 1 (provider, year) etc...
Attendance at Stage 2your full name
Attendance at Stage 3your full name
Attendance at other recognised safety course (give details)more details
0 /
Attaining unit standards relevant to Health and safety (please specify)
0 /
Recognition of current competency
How long an HSR?
Involvement in risk assessment?
Involvement in an incident investigation?
Involvement in hazard identification?
Involvement in assisting an injured worker return to work
Involvement in advocacy on behalf of workers in relation to health and safety
Involvement with Worksafe about an issue on the job
Involvement with workers ceasing work on account of a health and safety issue
Other Give details
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