Contact Person

Person completing this form (i.e. Assssor, ATC or Agent) *

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Contact Email *

Please provide an email address so we can contact the person making the application.

Contact Phone *

Please provide a phone number, in case we need to contact the person making the application.

Associated ATC Company/Organization Name for Invoicing *

An assessor's first application is covered by their assessor course fee. Subsequent applications for that assessor have an associated fee which is invoiced. ATC Administrators can check if previous designations have been approved by checking the assessors ITM profile (under designations). Visit www.ipsqa.com/fees for current pricing.

Assessor Details

Assessor Name *

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Last

Assessor IPSQA/ITM Number

This is available from their IPSQA certificate or ITM record.

Evidence Upload *

Click or drag files to this area to upload. You can upload up to 20 files.

Upload evidence to support assessor designation application. Evidence for CorePass must already be held on the assessors ITM profile (under documents). Max. 20Mb each file.

Certification Products

Indicate which certification products you are applying for the assessor to be able to assess, based on the above uploaded evidence. Please ensure you have reviewed the "Additional Assessor Requirements" noted on the syllabus within ITM.

CorePass (Non ISO17024)

• Community Emergency Response Training (CERT)
• Confined Space Awareness
• Dog Bite Prevention
• Height Safety I
• Height Safety II
• First Aid I (Basic)
• First Aid II (Intermediate)
• First Aid III (Advanced)
• First Aid IV (Maritime Medic)
• Flood Worker Safety
• INSARAG First Responder
• Life Saving - Bronze Medallion
• River Safety I
• Tactical Communications
• Workplace Fire Suppression I

CertPubS Designations (ISO17024)

• EVO Vehicle Vehicle Operator
• LRA Limited Rope Access
• PDO Dive Operator
• SAO Steep Angle Operator
• HAO High Angle Operator
• HAT High Angle Technician
• SWO Swiftwater Operator
• SWT Swiftwater Technician

Other ISO Products (ISO17024)

• ProQual NFPA 1006 Confined Space Operator
• ProQual NFPA 1006 Confined Space Technician
• WorkQual NFPA 350 Confined Space Entrant
• WorkQual IPSQA4001 Adventure Zip Line Rescue
• DefraQual Module 1 Flood Awareness
• DefraQual Module 2 Flood Responder
• DefraQual Module 3 Flood Technician
• DefraQual Module 4 Flood Boat Operator

Other Comments

If the certification product is not listed above, you may indicate it here, or make any other comment to assist with the application.

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Notice:

CorePass assessor designations applications require the assessor to hold suitable qualifications, including Additional Assessor Requirements (as per IPS010) where applicable. IPSQA will conduct an verification that such qualifications are on the assessor’s ITM profile (documents). 

All assessor designation for ISO17024 products (CertPubS, ProQual, WorkQual, DefraQual) are at the discretion of IPSQA and subject to review by expert panel. This may take up to 14 days. 

The assessor designation application fee is non-refundable and includes one re-submission if required. Re-submissions must be made within 14 days, otherwise a new application and fee is payable.