Form B - Amendment to Entity Information

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ADOSH-SF – Forms
Form B – Amendment to Entity Information - Version 4.0 – 15th July 2024 Page 1 of 2
Form B
General Information
Name of Entity:
Classification Code:: Registration Number:
Item Requiring Amendment Updated Information
 Type of Business Activities:
 Contact Details of Head
Office:
Address:
Coordinates:
Zone : _______________
Northing : _______________
Easting : _______________
Telephone No.: E-mail Address:
Fax No.: P.O. Box :
 Authorized Contact Person:
 Authorized Contact Person
Position:
 Contact Details of Authorized
Person:
Telephone No.: E-mail Address:
Fax No.: P.O. Box :
 Other Branches / Site Office:
Address: Coordinates:
Zone Northing Easting
 Location Map(s):  Current Location map(s) of Head Office and Branches are attached.
 Target Date for Completing
the Development of OSHMS:
(a) Original Target Date: __ __ (Day) __ __ (Month) __ __ __ __ (Year)
(b) New Target Date Proposed: __ __ (Day) __ __ (Month) __ __ __ __ (Year)
(c) Reason for Extension of Time Request:
Note: Implementation of the Entity’s OSHMS shall commence within 30 days of receiving
approval from the concerned SRA.
Note: Incident Reporting Requirements shall commence from the date of approval.
Note: OSH Performance Reporting Requirements shall commence in the quarter
following quarter of approval.
Note: Annual Third Party External Compliance Audit shall be undertaken with (12) twelve
months from the date of approval.

ADOSH-SF – Forms
Form B – Amendment to Entity Information - Version 4.0 – 15th July 2024 Page 2 of 2
Form B
Other Information requiring Amendment / Additional Information
(Please list and attach any relevant documents / evidence )
Comments:
Declaration
I declare that all information provided in this document is true, correct and complete.
Signature of the
Authorised
Contact Person:
Official
Stamp :
Date :
(DD/MM/YYYY) _____/_____/_____
Official Use
Remarks:
(a) Comment/Actions on the information submitted :
(b) Revised deadline for completing the development of OSHMS :
___ ___ (Day) ___ ___ (Month) ___ ___ ___ ___ (Year)
Relevant Authority Stamp Entered into Database by:
Name:
Signature:
Date: (DD/MM/YYYY) _____ / _____ / _____
Reviewed by:
Name:
Signature:
Date: (DD/MM/YYYY) _____ / _____ / _____