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COURSE NAME
COURSE NO
MODULE NAME
MODULE NO
PASS / FAILED
ATTEMPTS AND DATE
TIME (HRS)
STUDENT SIGNATURE
COACH SIGNATURE
COACH SALARY NO
MENTOR SIGNATURE
MENTOR SALARY NO
1
2
3
Low voltage switchgear
05408
Fuses
05149
Circuit breakers
05308
Isolators
05310
Relay and contactors
05311
Insulator
05312
Control rooms
05410
ID of control and mimic panels
05202
ID of battery room, alarm boards and DC lights
05163
ID of metering panels KWH
05159
Substation loading
05144
Identify recorders
05281
DECLARATION FORMS LEVEL 1
On-job training
NAME:
SALARY NO:
I hereby certify that the information contained on this declaration form is true and accurate.
Mentor (Surname and initials):
Mentor signature:
Date:
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