Replacement Card - Employer - WHS Foundation - Work Health & Safety Foundation

If you require a replacement High Risk Work Licence (HRWL) you will need to contact WorkSafe WA directly.

Complete this form if you are requesting a replacement white card, FOET or BOSIET card on behalf of your employee. Consent must be completed by the employee before we can issue training records.

A fee of $55 (including GST) per item will be applicable. Payment must be made prior to replacement record/s being issued.

Please allow up to 3 working days for processing. If you require it sooner please advise the required date and reason.

Employer Information

If you are the employer requesting this information on behalf of your worker please complete your details below. There is another section for the worker's details.

Date Required By

Reason for Replacement:(Required)

Company Name(Required)

Name(Required)

Phone(Required)

Email(Required)

Signature(Required)

Participant Details & Consent

Complete employees details. Please ensure you get the employee to sign below.

Full Name:(Required)

Date of Birth:(Required)

Postal Address:(Required)

Street Address City State / Territory Post Code Country

Email:(Required)

Phone Number:(Required)

Please indicated which you require:(Required)

White Card

FOET

BOSIET

Other

Card No. (If known)

Expiry Date:

Consent Question(Required)

I consent to the dates of my training for above being forwarded.

I consent to a copy of my record/s of competency for above being fowarded.

Signature(Required)

Date(Required)

Individual Replacement Card

Total

Credit Card(Required)

American Express

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Service

Academy

Categories

Replacement Card – Employer

Employer Information

Participant Details & Consent

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