BOOKING FORM - ENSA

BOOKING FORM

PO#

Date:(m/d/y)

Training course date:(m/d/y) Start: (m/d/y) Contact Personnel

Name of Company:

Finish: (m/d/y)

First Name

Last Name

Course Code:

Course Description:

WE1001

Safe Access & Rescue

Position/Title

Phone: (mobile or office)

e-mail

City

State/Prov.

Zip/Postal Code

City

State/Prov.

Zip/Postal Code

Company Contact Site Contact Billing address: Street

Site address: (location where training will be held) Street

Payment Details: Please invoice my company address as above

YES

NO Expiration: (m/y)

Credit Card No:

Security Code:

I have read and understood ENSA, A Division of Mallory Safety & Supply, LLC’s booking terms and conditions:

Signature:

ENSA - A Division of Mallory Safety and Supply, LLC. 5510 E. Marginal Way S. Seattle WA. 98134 800.525.7233

Date: (m/d/y)

ENSA Training Administration T: (262) 287-8689 E-mail: – [email protected] Website: ENSA-NorthAmerica.com

Transfer and Cancellation Policy: TERMS AND CONDITIONS:

To Book Training ENSA requires: • • •

A Purchase Order (PO) as per the provided quotation A fully completed Training Course Booking Form (this document) returned to ENSA, A Division of Mallory Safety & Supply, LLC. A temporary reservation for specific training dates can be made without a PO# which is only valid until the end of the next business day to allow time for PO creation.

ENSA Quotations include: • •

All training and related expenses (travel & accommodation, student equipment, freight and tax fees) See Quote sheet for details. Training per day charges based on group size and course duration and allowances for downtime

RUSH and/or Special requests •

Special training/audits and RUSH requests may have additional charges. These charges will be highlighted and included in the ENSA North America quotation.

Cancellations: • • •

ENSA, A Division of Mallory Safety & Supply, LLC.. reserves the right to impose the following penalties: 100% for cancellations made within 5 working days of training course start time, 50% for those made between 6 – 10 working days; and 25% for those made between 11 to 20 working days. ENSA, A Division of Mallory Safety & Supply, LLC.. is flexible to consider changes to training format but reserves the right to refuse all modifications to the training program once a training slot has been confirmed. Changes to the student roster on the Booking Form less than five days prior to the scheduled training will result in additional fees of $175.00 per student.

Payment Terms: • •

Full payment for the course must be received 21 days prior to the scheduled training unless an agreement with ENSA, A Division of Mallory Safety & Supply, LLC.. has been approved. All payments must be made in full and can be made by check, Credit card (Visa/MasterCard), cash or by wire/money transfer to ENSA, A Division of Mallory Safety & Supply, LLC.. ADDITIONAL CONDITIONS: (read and understand fully) • As required under Global Wind Organization (GWO) Approved Training Standard – Work at Height & Rescue – Wind Turbines (WAHR) Section 2.2.2 Medical & Fitness All delegates must be able to provide evidence of their capability and medical fitness top undergo the training. Training providers must demonstrate the existence of suitable systems to make explicit reference to the capability and medical fitness of the delegate to attend the training: 1) At the time of registration (booking) of the delegate onto the course; and 2) At the commencement of training, prior to any practical exercises being conducted. Suitable evidence for (1) shall include a medical certificate accepted by the delegates employing organization or a declaration by the employer stating acceptance of the medical fitness of the employee to attend the training Suitable evidence for (2) is the delegate’s self-declaration within the signing of the course registration form on the day of the training course. • Students are obliged to wear suitable clothing, work boots (with a heel if climbing). Students wishing to use their own PPE during training must bring the inspection and certification history. Students must attest they are medically fit and are aware of user weight limitations outlined under their OHS Act (Federal/State or Provincial) and are within the defined limitations specified will be required to sign an agreement to this effect before starting training. • ENSA, A Division of Mallory Safety & Supply, LLC.. reserves the right to suspend training at any time should the student’s medical condition be in question. - A delegate equipment list specific to training program is available upon request as per the course synopsis.



Issuing of ENSA Certification • • •

Upon evaluation all successful delegates are issued a wallet. Unsuccessful delegates will be informed immediately and all remediation options will be discussed with the delegate and supervisor on-site as appropriate. Within 45 days the delegate’s employer will be issued with digital versions of delegate certificate of training, permanent delegate ID cards, and a copy of the course registration form (liability waver), training session sign off (release waver) and the delegate’s evaluation documents. Clients registered under the ENSA CIP program – digital formal certificates, permanent wallet cards and copies of the specified training documents will be mailed to the above company contact person. (verification will be made at time of shipping).

Delegates to be enrolled; The following must be completed in full. Fitness – Initial of employer (authorized or person responsible) stating acceptance of the medical fitness of the employee to attend the training. Mandatory

Fitness

Optional

First Name

Last Name

Phone: (mobile or office)

e-mail

Authorized or responsible person please sign and date page one of this form and e-mail through to ENSA Training Administration.

