Winch Operator mine Assistant

CERTIFICATE Stillwa(er

*bahüé

NAME ** MiNe;

COMPANY:

COMMOOlTht

rev NO:

SURNAMS:

to t PASSPORT NO:

PERSONNEL AREA:

ORG UNIT:

OCCUPATION

Winch Operator

Thembeian\ Shatt

Platinum

Platinum

2703

Ndodana

SIGNIFICANT exposuREs

PARUCULARS OF MINE

POSTAL ADDRESS:

RESPONSIBLE OMP:

FAX NO:

PARTICULARS OF PERSON

NAMES:

PO Box 66 0350

Dr RC Tjate

jejpho

INDUSTRY I COMPANY NO: Z4464628

• OCCUPATION:

WORKPLACE:

, OREP:

OCCUPATIONAL HISTORY

FROM DATE TO DATE

Winch Operator

RPM-2P- Thembelani

Underground Warm

EMPLOYER COMMODITY

e\AMtNATtON ceroge; Rustenbul\)

oe EXAMINATION: 200$ 05-27

200805-29 2019-09-10

EXIT MEDICAL SUMMARY

Platinum

I DATE OF MEDICAL: : 2019-09-10

Sibanye Platinum

EXPOSURE CLASSIFICATION (RISK PROFILE)

AUDIOMETRY

Baseline

exit

pATIEN

OATE

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AUDIOMETRY

PLH PLH ABHU STSU UST 1.5

Shift

0.00 4.00 05 05

4.00 05 05

.00 3 75 3.33 00 15 15

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SIGNATUR S

DATE: 2019-09-10 WIT

.05 '05

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05, 25

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LO •STSR/ RST

05

00 10

1.67 8.33 1-5

10 05

00 10

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00 10

10

05 15

05 05

05 10

30 15

SIGNATUR

'faeknowledge that the contents ot t EüConiticate have been explained to-moo. DATE: 2019-09-10

Section 20(1)(b) of the MHSA, I may appeal against a P finding in this cedificate

l, Georgina Motau (ND Med Tech, BTe THI ERSON MEDICALLY Exit Completed

Mpbo Motau

SIGNATURE: MBCHB,DOHM

DATE: .19-09-1'0••

Nip 0638013

PN 0579440

Mobile NO'.

079*******

Created on 2019-09-10 09u28 by SBS\Z8705653

Printed on 2019-09-10 by Motau,Georgina

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