Company accreditation form

Industry Authorisation and accreditation Company accreditation form

Application for company accreditation form

Please note the following

Information collected in this document is for the purpose of assessing you and your employees’ ability to work on or near Evoenergy’s electricity network, safety related purposes, and any other purposes set out in our Privacy Policy. Our Privacy Policy explains how we collect, use, disclose and store your information. Read Evoenergy's privacy policy and security statement

Accreditation to work on or near Evoenergy’s electricity network will automatically lapse if an annual renewal is not received prior to the expiry date, each year. Evoenergy reserves its rights to deal with and report any unaccredited work undertaken on or near its electricity network to Worksafe ACT, the Utilities Technical Regulator or the Police.

*Denotes mandatory field

Company details

Company name *

ABN *

Company representative/contact *

Contact details

Phone number *

Mobile

Fax

Email address *

Postal address

Street address *

Suburb *

State *

Postcode *

Applicant declaration

I accept responsibility for work and actions taken by the listed employees whilst carrying out work on or near Evoenergy's network whilst employed by the accredited body nominated in this application.

I further declare that the above information is true, correct, and current.

I acknowledge that the above company is not accredited until this application and all supporting documentation has been received and assessed by Evoenergy, and a determination has been made.

I understand that to ensure currency of accreditation and authorisation, we, the nominated accredited body, will be required to update and maintain our mandatory documentation as required by Evoenergy.

Name *

Position title *

Date *