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Power engineer, housing and communal services job responsibilities. Power engineer of the workshop (site) Job description. Services managed by the chief power engineer

I. General provisions

1. An energy engineer belongs to the category of specialists.

2. A person with a higher professional (technical) education and work experience in the specialty in engineering positions of at least 3 years or secondary vocational (technical) education and work experience in the specialty in engineering positions is appointed to the position of energy engineer.

3. Appointment to the position of energy engineer and dismissal from it is made by order of the director of the enterprise upon nomination (head of the relevant structural unit; other official)

4. An energy engineer must know:

4.1. Resolutions, instructions, orders, methodological and regulatory materials on the operation of energy equipment and communications.

4.2. Organization of energy management.

4.3. Prospects for the technical development of the enterprise.

4.4. Technical characteristics, design features, operating modes and rules of technical operation of power equipment.

4.5. A unified system of scheduled preventive maintenance and rational operation of equipment.

4.6. Organization and technology of repair work.

4.7. Methods of installation, adjustment, adjustment and repair of power equipment.

4.8. The procedure for drawing up applications for energy resources, equipment, materials, spare parts, tools.

4.9. Rules for handing over equipment for repair and acceptance after repair.

4.10. Fundamentals of the production technology of the enterprise's products.

4.11. Requirements for labor organization during operation, repair and modernization of power equipment.

4.12. Advanced domestic and foreign experience in the operation and repair of power equipment.

4.13. Established tariffs for electrical energy.

4.14. Fundamentals of economics, organization of production and management.

4.15. Fundamentals of labor legislation.

4.16. Internal labor regulations.

4.17. Rules and regulations on occupational health, safety, industrial sanitation and fire safety.

5. The energy engineer reports directly to (the head of the relevant structural unit; other official)

6. During the absence of an energy engineer (illness, vacation, business trip, etc.), his duties are performed by a person appointed in the prescribed manner. This person acquires the corresponding rights and is responsible for the proper performance of the duties assigned to him.

II. Job responsibilities

Energy Engineer:

1. Ensures uninterrupted operation, proper operation, repair and modernization of energy equipment, electrical and heating networks, air and gas pipelines.

2. Determines the need of production for fuel and energy resources, prepares the necessary justification for technical re-equipment, development of the energy sector, reconstruction and modernization of energy supply systems.

3. Draws up requests for the purchase of equipment, materials, spare parts necessary for the operation of the energy sector, performs calculations with the necessary justification for measures to save energy resources, the needs of enterprise divisions for electrical, thermal and other types of energy, participates in the development of norms for their consumption, operating modes of divisions enterprises based on energy needs.

4. Draws up schedules for reducing energy loads during hours of maximum load on the energy system and ensures their implementation within the limits of the value determined for the divisions of the enterprise, carries out certification of energy, electrical and environmental installations installed at the enterprise.

5. Participates in testing and acceptance of power plants and networks for industrial operation, in considering the causes of accidents of power equipment and develops measures to prevent them and create safe working conditions.

6. Organizes inspection and testing of relay protection and automation equipment.

7. Carries out technical supervision of instrumentation, electrical and thermal equipment used at the enterprise, and also ensures the preparation of pressure vessels, steam and hot water pipelines, electrical installations and other energy facilities for acceptance into operation, inspection and certification by authorities state supervision.

8. Monitors compliance with instructions for operation, maintenance and supervision of equipment and electrical networks.

9. Participates in the development and implementation of standards and technical specifications for power equipment.

10. Prepares the necessary materials for concluding contracts for equipment repairs with contractors.

11. Monitors the implementation of major and other repairs of power equipment.

12. Studies and summarizes advanced domestic and foreign experience in the rational use and saving of fuel and energy resources.

13. Ensures compliance with labor safety rules and regulations during operation and repair of power plants and networks.

14. Prepares reporting according to approved forms and indicators.

15. Performs individual official assignments of his immediate superior.

III. Rights

An energy engineer has the right:

1. Get acquainted with the draft decisions of the enterprise management concerning its activities.

2. Submit proposals for improvement of work related to the responsibilities provided for in this job description for management’s consideration.

3. Inform your immediate supervisor about all shortcomings in the production activities of the enterprise (its structural divisions) identified during the performance of your official duties and make proposals for their elimination.

4. Request personally or on behalf of the immediate supervisor from the heads of departments of the enterprise and specialists for information and documents necessary to fulfill his official duties.

5. Involve specialists from all (individual) structural divisions in solving the tasks assigned to it (if this is provided for by the regulations on structural divisions, if not, then with the permission of management).

6. Demand that the management of the enterprise provide assistance in the performance of its official duties and rights.

IV. Responsibility

The energy engineer is responsible for:

1. For improper performance or failure to fulfill one’s job duties provided for in this job description within the limits determined by the current labor legislation of the Russian Federation.

2. For offenses committed in the course of carrying out their activities within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.

3. For causing material damage within the limits determined by the current labor and civil legislation of the Russian Federation.

Energy engineer's instructions

I. General provisions

1. An energy engineer belongs to the category of specialists.
2. A person with a higher professional (technical) education and work experience in the specialty in engineering positions of at least 3 years or secondary vocational (technical) education and work experience in the specialty in engineering positions is appointed to the position of energy engineer.
3. Appointment to the position of energy engineer and dismissal from it is made by order of the director of the enterprise upon nomination (head of the relevant structural unit; other official)
4. An energy engineer must know:
4.1. Resolutions, instructions, orders, methodological and regulatory materials on the operation of energy equipment and communications.
4.2. Organization of energy management.
4.3. Prospects for the technical development of the enterprise.
4.4. Technical characteristics, design features, operating modes and rules of technical operation of power equipment.
4.5. A unified system of scheduled preventive maintenance and rational operation of equipment.
4.6. Organization and technology of repair work.
4.7. Methods of installation, adjustment, adjustment and repair of power equipment.
4.8. The procedure for drawing up applications for energy resources, equipment, materials, spare parts, tools.
4.9. Rules for handing over equipment for repair and acceptance after repair.
4.10. Fundamentals of the production technology of the enterprise's products.
4.11. Requirements for labor organization during operation, repair and modernization of power equipment.
4.12. Advanced domestic and foreign experience in the operation and repair of power equipment.
4.13. Established tariffs for electrical energy.
4.14. Fundamentals of economics, organization of production and management.
4.15. Fundamentals of labor legislation.
4.16. Internal labor regulations.
4.17. Rules and regulations on occupational health, safety, industrial sanitation and fire safety.
5. The energy engineer reports directly to (the head of the relevant structural unit; other official)
6. During the absence of an energy engineer (illness, vacation, business trip, etc.), his duties are performed by a person appointed in the prescribed manner. This person acquires the corresponding rights and is responsible for the proper performance of the duties assigned to him.

II. Job responsibilities

Energy Engineer:
1. Ensures uninterrupted operation, proper operation, repair and modernization of energy equipment, electrical and heating networks, air and gas pipelines.
2. Determines the need of production for fuel and energy resources, prepares the necessary justification for technical re-equipment, development of the energy sector, reconstruction and modernization of energy supply systems.
3. Draws up requests for the purchase of equipment, materials, spare parts necessary for the operation of the energy sector, performs calculations with the necessary justification for measures to save energy resources, the needs of enterprise divisions for electrical, thermal and other types of energy, participates in the development of norms for their consumption, operating modes of divisions enterprises based on energy needs.
4. Draws up schedules for reducing energy loads during hours of maximum load on the energy system and ensures their implementation within the limits of the value determined for the divisions of the enterprise, carries out certification of energy, electrical and environmental installations installed at the enterprise.
5. Participates in testing and acceptance of power plants and networks for industrial operation, in considering the causes of accidents of power equipment and develops measures to prevent them and create safe working conditions.
6. Organizes inspection and testing of relay protection and automation equipment.
7. Carries out technical supervision of instrumentation, electrical and thermal equipment used at the enterprise, and also ensures the preparation of boilers, vessels operating under pressure, steam and hot water pipelines, electrical installations and other energy facilities for acceptance into operation, inspection and certification by authorities state supervision.
8. Monitors compliance with instructions for operation, maintenance and supervision of equipment and electrical networks.
9. Participates in the development and implementation of standards and technical specifications for power equipment.
10. Prepares the necessary materials for concluding contracts for equipment repairs with contractors.
11. Monitors the implementation of major and other repairs of power equipment.
12. Studies and summarizes advanced domestic and foreign experience in the rational use and saving of fuel and energy resources.
13. Ensures compliance with labor safety rules and regulations during operation and repair of power plants and networks.
14. Prepares reporting according to approved forms and indicators.
15. Performs individual official assignments of his immediate superior.

An energy engineer has the right:
1. Get acquainted with the draft decisions of the enterprise management concerning its activities.
2. Submit proposals for improvement of work related to the responsibilities provided for in this job description for management’s consideration.
3. Inform your immediate supervisor about all shortcomings in the production activities of the enterprise (its structural divisions) identified during the performance of your official duties and make proposals for their elimination.
4. Request personally or on behalf of the immediate supervisor from the heads of departments of the enterprise and specialists for information and documents necessary to fulfill his official duties.
5. Involve specialists from all (individual) structural units in solving the tasks assigned to it (if this is provided for by the regulations on structural units, if not, then with the permission of management).
6. Demand that the management of the enterprise provide assistance in the performance of its official duties and rights.

IV. Responsibility

The energy engineer is responsible for:
1. For improper performance or failure to fulfill one’s job duties as provided for in this job description - within the limits determined by the current labor legislation of the Russian Federation.
2. For offenses committed in the course of carrying out their activities - within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.
3. For causing material damage - within the limits determined by the current labor and civil legislation of the Russian Federation.

I CONFIRM:

[Job title]

_______________________________

_______________________________

[Name of company]

_______________________________

_______________________/[FULL NAME.]/

"______" _______________ 20___

JOB DESCRIPTION

Energy engineer

1. General Provisions

1.1. This job description defines and regulates the powers, functional and job responsibilities, rights and responsibilities of an energy engineer [Name of the organization in the genitive case] (hereinafter referred to as the Company).

1.2. An energy engineer is appointed to a position and dismissed from a position in the manner established by current labor legislation by order of the head of the Company.

1.3. An energy engineer belongs to the category of specialists and is subordinate to [names of subordinate positions in the dative case].

1.4. The energy engineer reports directly to [name of the immediate supervisor's position in the dative case] of the Company.

1.5. A person with the appropriate qualifications is appointed to the position of energy engineer:

Energy engineer category I: higher professional (technical) education and work experience as a category II power engineer for at least 3 years.

Power engineer II category: higher professional (technical) education and work experience as a power engineer or other engineering and technical positions filled by specialists with higher professional education for at least 3 years.

Energy Engineer: higher professional (technical) education without requirements for work experience or secondary vocational education (technical education and work experience as a category I technician for at least 3 years or other positions filled by specialists with secondary vocational education for at least 5 years.

1.6. The energy engineer is responsible for:

  • effective performance of the work assigned to him;
  • compliance with the requirements of performance, labor and technological discipline;
  • the safety of documents (information) in his custody (that have become known to him) containing (constituting) the Company’s trade secret.

1.7. An energy engineer must know:

  • decrees, instructions, orders, methodological and regulatory materials on the operation of energy equipment and communications;
  • organization of energy management;
  • prospects for technical development of the enterprise;
  • technical characteristics, design features, operating modes and rules of technical operation of power equipment;
  • A unified system of scheduled preventive maintenance and rational operation of equipment;
  • organization and technology of repair work;
  • methods of installation, adjustment, adjustment and repair of power equipment;
  • the procedure for drawing up applications for energy resources, equipment, materials, spare parts, tools;
  • rules for handing over equipment for repair and acceptance after repair;
  • fundamentals of the production technology of the enterprise's products;
  • requirements for labor organization during operation, repair and modernization of power equipment;
  • advanced domestic and foreign experience in the operation and repair of power equipment;
  • fundamentals of economics, organization of production, labor and management;
  • basics of labor legislation;
  • rules and regulations of labor protection.

1.8. An energy engineer in his activities is guided by:

  • local acts and organizational and administrative documents of the Company;
  • internal labor regulations;
  • rules of labor protection and safety, ensuring industrial sanitation and fire protection;
  • instructions, orders, decisions and instructions from the immediate supervisor;
  • this job description.

1.9. During the period of temporary absence of an energy engineer, his duties are assigned to [deputy position title].

2. Job responsibilities

An energy engineer is required to perform the following labor functions:

2.1. Ensures uninterrupted operation, proper operation, repair and modernization of energy equipment, electrical and heating networks, air and gas pipelines.

2.2. Determines production needs for fuel and energy resources, prepares the necessary justification for technical re-equipment, development of the energy sector, reconstruction and modernization of energy supply systems.

2.3. Draws up requests for the purchase of equipment, materials, spare parts necessary for the operation of the energy sector, performs calculations with the necessary justification for measures to save energy resources, the needs of enterprise divisions for electrical, thermal and other types of energy, participates in the development of standards for their consumption, operating modes of enterprise divisions, based on their energy needs.

2.4. Monitors compliance with fuel consumption standards and all types of energy.

2.5. Draws up schedules for reducing energy loads during hours of maximum load on the energy system and ensures their implementation within the limits determined for the enterprise division, carries out certification of energy, electrical and environmental installations installed at the enterprise.

2.6. Participates in testing and acceptance of power plants and networks for industrial operation, in examining the causes of accidents of power equipment and develops measures to prevent them and create safe working conditions.

2.7. Organizes inspection and testing of relay protection and automation equipment.

2.8. Carries out technical supervision of instrumentation, electrical and thermal equipment used at the enterprise, and also ensures the preparation of boilers, pressure vessels, steam and hot water pipelines, electrical installations and other energy facilities for acceptance into operation, inspection and certification by government agencies supervision.

2.9. Monitors compliance with instructions for operation, maintenance and supervision of energy equipment and electrical networks.

2.10. Participates in the development and implementation of standards and technical specifications for power equipment.

2.11. Prepares the necessary materials for concluding contracts for equipment repairs with contractors.

2.12. Monitors the implementation of major and other repairs of power equipment.

2.13. Studies and summarizes advanced domestic and foreign experience in the rational use and saving of fuel and energy resources, promotes its implementation, as well as the development of creative initiative and activity of employees.

2.14. Ensures compliance with labor safety rules and regulations during the operation and repair of power plants and electrical networks.

2.15. Prepares reports according to approved forms and indicators.

In case of official necessity, an energy engineer may be involved in the performance of his official duties overtime, in the manner prescribed by the provisions of federal labor legislation.

3. Rights

An energy engineer has the right:

3.1. Give instructions and tasks to his subordinate employees and services on a range of issues included in his functional responsibilities.

3.2. Monitor the implementation of production tasks, timely completion of individual orders and tasks by the services subordinate to him.

3.3. Request and receive the necessary materials and documents related to the activities of the energy engineer, his subordinate services and departments.

3.4. Interact with other enterprises, organizations and institutions on production and other issues within the competence of an energy engineer.

3.5. Sign and endorse documents within your competence.

3.6. Submit proposals on the appointment, relocation and dismissal of employees of subordinate departments for consideration by the head of the Company; proposals to encourage them or to impose penalties on them.

3.7. Use other rights established by the Labor Code of the Russian Federation and other legislative acts of the Russian Federation.

4. Responsibility and performance evaluation

4.1. The power engineer bears administrative, disciplinary and material (and in some cases provided for by the legislation of the Russian Federation, criminal) responsibility for:

4.1.1. Failure to carry out or improperly carry out official instructions from the immediate supervisor.

4.1.2. Failure to perform or improper performance of one's job functions and assigned tasks.

4.1.3. Illegal use of granted official powers, as well as their use for personal purposes.

4.1.4. Inaccurate information about the status of the work assigned to him.

4.1.5. Failure to take measures to suppress identified violations of safety regulations, fire safety and other rules that pose a threat to the activities of the enterprise and its employees.

4.1.6. Failure to ensure compliance with labor discipline.

4.2. The assessment of the work of an energy engineer is carried out:

4.2.1. By the immediate supervisor - regularly, in the course of the employee’s daily performance of his labor functions.

4.2.2. The certification commission of the enterprise - periodically, but at least once every two years, based on documented results of work for the evaluation period.

4.3. The main criterion for assessing the work of an energy engineer is the quality, completeness and timeliness of his performance of the tasks provided for in this instruction.

5. Working conditions

5.1. The work schedule of an energy engineer is determined in accordance with the internal labor regulations established by the Company.

6. Signature right

6.1. To ensure his activities, the energy engineer is given the right to sign organizational and administrative documents on issues within his competence by this job description.

I have read the instructions ___________/___________/ “____” _______ 20__

The profession of energy engineer is a position in which a person monitors the operation of complex electrical devices and networks. This profession became in demand with the advent of electricity as such.

A little history

The first energy scientist can be considered the man who was able to discover and harness electricity - Thomas Edison. The first power station he created in the 80s of the 19th century was a mass of various devices, complex designs and purposes that required constant monitoring and control. It was at this moment that the need for qualified personnel capable of exercising control arose. Today, electricity is one of the main elements of the comfortable existence of mankind, so now an energy engineer is one of the most in-demand professions.

Description of the profession of energy engineer

The profession of power engineers is one of the most dangerous types of activity, because it is associated with the operation of high-voltage devices and networks, and this threatens with electric shock.

Power engineers have two levels of qualification, the first is a simple specialist, and the second is an energy engineer.

A simple specialist is a person who has secondary education in a given field, has worked in his position for no more than 5 years and has not yet received advanced training. An energy engineer is a person with a higher education and more than 3 years of work experience. He has a little more responsibilities, which is what interests us.

Energy Engineer: Responsibilities

People in this profession have a large list of responsibilities, here are some of them:

  • Ensures constant uninterrupted operation of power equipment of thermal and electrical networks, and also monitors the correct operation of them, repairs and modernizes equipment.
  • Maintains control over the consumption of fuel and energy resources at the enterprise. Finds justifications for equipment modernization, development of energy saving systems and their modernization.
  • Monitors the condition of equipment, and also draws up requests for the purchase of materials, additional equipment and spare parts, justifying their need. Participates in the development of consumption standards and operating modes of the enterprise, focusing on energy consumption.
  • Participates in testing and acceptance of installed power equipment, considers the causes of accidents and strives to reduce the number of malfunctions and create safe working conditions by developing measures to prevent breakdowns.
  • Draws up graphs of electricity consumption and loads on the electrical grid. Monitors the condition of environmental, electrical and energy installations installed at the enterprise.
  • Checks the condition of energy protection systems and automation, develops a set of measures to prevent accidents.
  • Carries out control and supervision of measuring instruments used at the enterprise. If this is a heat power plant, it is also required to prepare boilers operating under pressure, monitor the condition of pipelines for hot water and steam, and prepare equipment for inspection by state control authorities.
  • Supervises compliance with equipment operating procedures and instructions for their operation and maintenance.
  • Participates in the development of enterprise standards for power equipment.
  • Prepares packages of documents for concluding contracts with third parties for various works and services.
  • Supervises the overhaul of equipment.
  • Introduces the experience of foreign and more developed organizations into the work of the enterprise, studies reporting to develop new methods of work.
  • Carry out instructions from his immediate supervisor, usually the chief energy engineer.
  • Prepares reports according to the standards established at the enterprise.

This is not the entire list of what an energy engineer should do at an enterprise. The responsibilities of this specialist are difficult to define within any framework.

Knowledge that an energy engineer must have

The profession obliges specialists to have certain knowledge in the field of energy. To perform his duties correctly, he must know:

  • Orders, resolutions, instructions and other regulations on the operation of power equipment.
  • The procedure for organizing the energy sector.
  • Rules for working with power equipment, its structure, design features and operating mode.
  • Technology for performing equipment repair work.
  • Rules for drawing up applications for the supply of energy resources, equipment, spare parts, tools and materials.
  • Methods of repair, installation and adjustment of power equipment.
  • Fundamentals of economics and enterprise management.
  • Some issues of labor law, basics of work organization, labor protection rules.

Summary. Energy Engineer

A resume for a job search as an energy engineer is compiled in the same form as any other; it must indicate everything that is necessary to obtain the desired position. First, you need to mention the education you received; it must be higher, otherwise you cannot count on getting the position of energy engineer. Next, it is necessary to mention all information about previous places of work, positions held, duties that were previously performed. It could be:

  • reading electrical and hydraulic diagrams;
  • ability to maintain power equipment;
  • troubleshooting;
  • installation, adjustment and control over the condition of electrical installations.

You can also indicate organizational skills and other information that may be of interest to a future manager at the enterprise in order to obtain the position of energy engineer. The duties that you previously performed at previous enterprises are the main criterion on which they rely when choosing a future employee, so try to reflect all the most important data.

Specialist rights

Like any employee, an energy engineer not only must perform duties, but also has the right:

  • Familiarize yourself with the regulations and other acts of the manager regarding the activities he performs.
  • Make proposals for improving the operation of the enterprise within its range of activities.
  • Report to the manager, within the scope of his competence, about all shortcomings in the operation of the enterprise and make proposals for eliminating them or improving the activities of the enterprise.
  • Request, within your competence, or on behalf of your immediate supervisor, the necessary documents.
  • Express your demands to management regarding the need for assistance in performing their duties.

Conclusion

This information fully reflects the characteristics of the activities and labor regulation of such an employee as an energy engineer. This instruction is not mandatory, but can be used to compile a list of the rights and responsibilities of an employee at the enterprise.

Job Description for Energy Technician[name of organization, enterprise]

This job description was developed and approved in accordance with the provisions, Resolution of the Ministry of Labor of the Russian Federation dated December 31, 2003 N 94 “On approval of the qualification directory of positions of managers, specialists and other employees of nuclear energy, industry and science organizations” and other regulations governing labor relations.

1. General Provisions

1.1. The energy technician belongs to the category of specialists and is directly subordinate to [name of the manager's position].

1.2. A person with a secondary vocational (technical) education is accepted for the position of energy technician, without presenting any work experience requirements.

1.3. An energy technician is hired and dismissed from work by order of [position of the head of the organization].

1.4. An energy technician must know:

Resolutions, instructions, orders and other guidance, methodological and regulatory documents on energy maintenance of electrical facilities;

Prospects for the technical development of electrical equipment;

Technical characteristics, design features, rules of technical operation of energy equipment and energy networks;

The procedure for drawing up applications for power equipment, spare parts, tools, materials and fuel and energy resources;

The procedure for the development and execution of technical documentation;

Basics of production technology;

Fundamentals of economics, organization of production, labor and management;

Fundamentals of labor legislation;

Rules on labor protection, environmental protection, industrial sanitation and fire safety.

1.5. Professionally important qualities: [list qualities].

2. Job responsibilities of the employee

The energy technician is assigned the following job responsibilities:

2.1. Provides, under the guidance of a more qualified specialist, the operation, repair and modernization of energy equipment, structures and energy networks.

2.2. Draws up schedules for preventative maintenance of equipment and networks.

2.3. Participates in the preparation of requests for equipment, spare parts and other materials necessary for the energy sector.

2.4. Takes part in the preparation of materials for the development of plans for the introduction of new equipment, technology, complex means of mechanization, telemechanization and automation of technological processes, automated production control systems.

2.5. Participates in the development of measures for the economical and rational use of material and fuel and energy resources.

2.6. Monitors compliance with fuel consumption standards and all types of energy.

2.7. Prepares test schedules for power equipment, participates in its testing, characterization and drawing up performance maps.

2.8. Places orders, receives and issues technical documentation for the operation of equipment.

2.9. Monitors changes to equipment operating instructions and executive diagrams of power plants and networks.

2.10. Keeps records of the availability and movement of equipment, technical documentation and operational reporting.

2.11. Participates in work on certification and rationalization of workplaces.

3. Employee rights

An energy technician has the right:

3.1. For all social guarantees provided for by law.

3.2. Require the management of the enterprise to provide assistance in the performance of their professional duties and the exercise of rights.

3.3. To pay additional expenses for medical, social and professional rehabilitation in cases of health damage due to an industrial accident and occupational disease.

3.4. Get acquainted with draft decisions of the enterprise management concerning its activities.

3.5. Request personally or on behalf of your immediate supervisor documents, materials, tools, etc., necessary to perform your job duties.

3.6. Other rights provided for by labor legislation.

4. Responsibility of the employee

The energy technician is responsible for:

4.1. For failure to perform or improper performance of one’s job duties as provided for in this job description - within the limits determined by the current labor legislation of the Russian Federation.

4.2. For causing material damage to the employer - within the limits determined by the current labor and civil legislation of the Russian Federation.

4.3. For offenses committed in the course of carrying out their activities - within the limits determined by the current administrative, criminal, and civil legislation of the Russian Federation.

Head of structural unit [initials, surname]

[signature]

[day month Year]

Agreed:

Head of Legal Department [initials, surname]

[signature]

[day month Year]

I have read the instructions: [initials, surname]

[signature]

[day month Year]