Contact Person

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

First

Last

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 (if applicable)

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 *

First

Last

Assessor IPSQA/ITM Number

This is available from their IPSQA certificate or ITM record.

Assessor Qualifications & 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). If your certifications are older than 24 months, attach evidence of currency such as certificates, diplomas, transcripts, logs or letters of attestation. Max. 20Mb each file.

ID Photo Upload

Click or drag a file to this area to upload.

If you do not have an ITM record with an ID photo displayed, or you are unsure, please upload a head and shoulders photo (professional style). Under 2Mb, and dimensions 150 (wide) x 200 (height), colour. Only PNG, JPG and GIF formats.

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)

• Aircraft Safety
• Body Worn Camera Operator
• Community Emergency Response Training (CERT)
• Competent Swimmer
• Competent Life Jacket User
• Confined Space Awareness
• DEFRA Module 1 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
• Public Safety Radio
• River Safety I
• Tactical Communications
• Tower Rescue Awareness
• Workplace Fire Suppression I

CertPubS & Award Designations (ISO17024)

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

Other ISO Products (ISO17024)

• ProQual NFPA 1006 Confined Space Operator
• ProQual NFPA 1006 Confined Space Technician
• ProQual NFPA 1006 Tower Rescue Operator
• WorkQual NFPA 350 Confined Space Entrant
• WorkQual IPSQA4001 Adventure Zip Line Rescue
• DefraQual Module 2 Flood Responder (See CorePass for Module 1)
• DefraQual Module 3 Flood Technician
• DefraQual Module 4 Flood Boat Operator
• DefraQual Flood Rescue Team Commander

Global Availability/Freelance Assessor *

• Yes
• No

Add me to the global shared record in ITM, so that any ATC can search for me as I an open to be contacted for freelance assessor opportunities

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.

Additional Designation Application Fee *

Price: $75.00

NZD

Agreement *

• I/we agree

I/we agree to the IPSQA Code of Conduct available from www.ipsqa.com/conduct and IPSQA Privacy Policy available from www.ipsqa.com/privacy. I/we understand this fee is not refundable and designations are subject to determination by IPSQA.

Total

$0.00

Stripe Credit Card *

Submit

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. 

A fee applies for additional designation applications and is not refundable. One re-submission is permitted, however re-submissions must be made within 14 days, otherwise a new application and fee is payable.