N Y Y N Y N Date Practicable Machine Testing Application Form Applicants Name to be tested Date Applicant to be tested Applicant being tested by Senior Mine Engineer Notified Name HR Notified Name Signature Security Notified Name Signature DAMS will supply Personal Protective Equipment to Applicant Applicant must return Personal Protective Equipment to DAMS once practical testing is accomplished Upon request from trainer Applicant may be issued with a chop voucher Applicant must be accompanied at all times while on site For safety reasons once practicable testing completed and PPE returned applicant must be escorted to gate Trainer to complete assessment form of applicant during practicable testing Personal Protective Equipment returned Chop Voucher required Assessment form completed Note: This form is for doing practical testing of personnel who are not an employee of DAMS but are considered for future employment and may have to be accompanied to the pit for practical testing on a DAMS machine. Note: This form is for records to be kept by HR and Training as evidence of practicable testing for candidates who have submitted applications for employment and are recognized as competent operators. Signature

Practicable Machine Testing Application Form

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Sample Practicable Machine Testing Application Form

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Date

Practicable Machine Testing Application FormApplicants Name to be tested

Date Applicant to be tested

Applicant being tested by

Senior Mine Engineer Notified NameSignature

HR Notified NameSignature

Security Notified NameSignature

DAMS will supply Personal Protective Equipment to ApplicantApplicant must return Personal Protective Equipment to DAMS once practical testing is accomplishedUpon request from trainer Applicant may be issued with a chop voucherApplicant must be accompanied at all times while on siteFor safety reasons once practicable testing completed and PPE returned applicant must be escorted to gateTrainer to complete assessment form of applicant during practicable testing

YNPersonal Protective Equipment returned

YNChop Voucher requiredAssessment form completed

Applicants SignatureTrainers NameTrainers Signature Date

Note: This form is for doing practical testing of personnel who are not an employee of DAMS but are considered for future employment and may have to be accompanied to the pit for practical testing on a DAMS machine.Note: This form is for records to be kept by HR and Training as evidence of practicable testing for candidates who have submitted applications for employment and are recognized as competent operators.