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IMCA Offshore Diving Supervisor Certification Scheme

Examination Application Bell Diving Supervisor


This form must be completed in full by the sponsoring company (i.e. the candidates current or most recent employer), signed by
that companys nominated authorised signatory and sent directly to the IMCA Certification Schemes Administrator. All specified
attachments must be enclosed with the form and it shall be understood that additional documentation may sometimes be
requested.
The current fee is 150 per compulsory module plus 25 per optional module.
Three passport-sized photographs of the applicant will be required before a certificate is issued.

Applicant Details:
Surname:

.............................................................................................................................................................

Forename(s):

.............................................................................................................................................................

Address:

.............................................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

E-mail address:

............................................................................................................................................... (optional)

Offshore Bell Diver Experience


Diver training certificate number:

................................................................................................................

Issuing authority:

................................................................................................................

Years experience:

...................................................................

Number of lockout hours:

...................................................................

Please attach a photocopy of the diver training certificate

Trainee/Air Diving Supervisor Experience


IMCA/AODC Air Diving Supervisor certificate number (if applicable):

...................................................................

Please attach a photocopy of the IMCA/AODC certificate (if applicable)

Total number of offshore air dives supervised (if appropriate):

...................................................................

If the applicant is not a qualified IMCA/AODC Air Diving Supervisor:


Trainee Air Diving Supervisor course date:

................................................................................................................

Training course place:

................................................................................................................

Please attach a photocopy of the trainee air diving supervisor course completion certificate

Total number of offshore commercial air dives supervised:

...................................................................

Please attach photocopies of all letters of appointment.


Examination Application Form Bell Diving Supervisor (updated December 2006)

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Trainee Bell Diving Supervisor Experience


Training course date:

................................................................................................................

Training course place:

................................................................................................................

Please attach a photocopy of the trainee bell diving supervisor course completion certificate

Date of first appointment (following course):

...................................................................

Please attach photocopies of all letters of appointment. If the date of first appointment is more than two years ago, please
also attach copies of logbook entries for the past two years.

Days worked as a Trainee Bell Diving Supervisor (since course):

...................................................................

Supervised panel hours logged as Trainee Bell Diving Supervisor (since course): ................................................................
Number of bell runs supervised (since course):

...................................................................

LST Experience
Hours logged as an Assistant/LST:

...................................................................

or

IMCA/AODC LST certificate number:

...................................................................

Please attach a photocopy of the IMCA/AODC certificate (if applicable)

Optional Legislation Modules Applied For




British


Norwegian

For completion by the companys Nominated Authorised Signatory

(i.e. Safety Manager or person of similar or higher standing within the company)

I confirm that I have personally seen the applicants logbook(s) and the originals of the attached
documents and that I can verify that the information set out above is correct. On the basis of
satisfactory offshore reports, confirming competence in accordance with IMCA guidance on
competence assurance and assessment, I recommend that:
................................................................................................................................................ (name)
is a suitable candidate for Bell Diving Supervisor.
Signed:

.....................................................................................................

Name:

.....................................................................................................

Position:

.....................................................................................................

Company name and stamp:

.....................................................................................................

Address:

.....................................................................................................
.....................................................................................................
.....................................................................................................

Date:

.....................................................................................................

Examination Application Form Bell Diving Supervisor (updated December 2006)

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Completed application forms should be submitted to:

Mrs Vicki Graham, Certification Schemes Administrator


IMCA, Manurewa, Midmill, Kintore, Aberdeenshire, AB51 0XA, UK

Examination Application Form Bell Diving Supervisor (updated December 2006)

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