2. HSE Review Record

• Document No.

Employer Details

• Company name.

• Workplace address (Including postcode)
  Address

• Number of Employees.

• Nature of business.

• Insurers name:

• Date.

  Date

• Policy number:

• Day of Month:

• Expiry Month:

• Expiry Year:

• Main contact person.

• Phone number.

• Health and safety contact.

• Email address.

• T2000 Area/Dept Appraisal.

• Type of work carried out by the learner at the workplace location.

• CDA/LA Name.

Risk Banding

• Risk Banding

  Select H M L

  • H
  • M
  • L

• Next Assessment due date

  Date

Authorisation of Placement

• Fully approved.

• Conditionally Approved (Subject to completion of Development Plan).

• Unsatisfactory.

• Authorising Signature.

  Sign

Review

• Company

• Review Type

• Physical

• Desktop Audit

• Note to the HSE Advisor: Is there and action plan / reports of none-conformance linked to the company? If yes, give details below.

Questions

• 1. Have there been any changes since the initial assessment? Eg relocation, ownership, name etc?

  Yes

  No

• 2. Have the Health and Safety Policy / Risk Assessments been reviewed?

  Yes

  No

• 3. Is there a sample of the documentation within the company file?

  Yes

  No

• 4. Has the learner been involved in an accident in the workplace since training commenced?

  Yes

  No

• 5. Has the learner been involved in a fire drill since the initial appraisal?

  Yes

  No

• 6. Has the HSE Advisor received a tour of the workplace?

  Yes

  No

• 7. Do suitable and sufficient control measures appear to be in place?

  Yes

  No

• 8. Has the learner(s) received any other Health and Safety Training through the employer

  Yes

  No

• Detail of action plan arising from the review (stating follow up / completion date)

The employer or their representative sign to agree this is an accurate record of assessment

• Name & Job Title

  Sign

• To the Authorising Officer:
  It is recommended that the above named organisation should be regarded as:-
  Approved.
  Conditionally Approved. ( Subject to Completion of Development Plan)
  Unsatisfactory.
  As a training provider of work experience / on the job training for Training 2000 Ltd.

• HSE Advisor Signature.

  Sign

H&S FM025 (a)