DTJ New Star

• Project Name:

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• Project No.:

• Document

• Date:

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• First Name:

• Last Name:

• Primary Language?

• I understand and speak English?

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  No

• Operative requires translator or translated documents?

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  Yes

• Address:

• Phone #

• Date of Birth:

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• Emergency Contact Name:

• Contact Number:

• Medical Details: Please alert your supervisor of any conditions that may affect you, your work or any safety on site.

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Training Details

• Upload clear photos of the required training certificates. Wall Steel will verify certs prior to your start.

• Safe Pass Card (front) (or official letter if issued in last three weeks)

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• Safe Pass Expiry Date?

  Date

• Safe Pass Number:

• Manual Handling Certificate

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• Manual Handling Expiry Date?

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• First Aider

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• First Aider Expiry Date?

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• MEWP (IPAF or Equivalent) Front & Back

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• MEWP Expiry Date?

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• CSR Card (NI) Front & Back

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• CSR Expiry Date?

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• NPORS 360 Front & Back

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• NPORS Expiry Date?

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• Slinger/Signaller Front & Back

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• Slinger/Signaller Expiry Date?

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• Abrasive Wheels

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• Abrasive Wheels Expiry Date?

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• Working @ Height

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• W@H Issue Date?

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• Mobile Crane

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• Mobile Crane Expiry Date?

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• Lift Supervisor

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• SSSTS

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• SSSTS Expiry Date?

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• SMSTS

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• SMSTS Expiry Date?

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• Appointed Person

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• AP Expiry Date?

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• Harness Instructor

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• Harness Instructor Expiry Date?

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• CPCS (UK) Front and Back

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• CPCS Expiry Date?

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• I Confirm that I understand the following Site Rules & Information and I understand the expected positive behavior required to work on this site:

• Duties of the Employer (Section 8 SHWW 2005) Wall Steel will provide - 1. Safe place of work. 2. Safe plant & equipment. 3. Safe systems of work. 4. Competent employees.

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• Duties of the Employee (Section 8 SHWW 2005) I will - 1. Take reasonable care of self and others. 2. Co-operate with employers' procedures and systems of work. 3. Make correct use of PPE supplied. 4. Report defects and dangers to management.

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• I will comply with the Accident / Incident / Near Miss reporting procedures

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• I will comply with the Site emergency procedures including the location of Emergency Assembly point(s) assembly

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• I will comply with Site housekeeping arrangements and expectations

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• I will comply with Working at Height procedures & site rules

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• I will comply with Permit to work procedures on this project

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• I will comply with Wall Steel Exclusion Zone Policy once communicated by site manager/supervisor

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Personal Protective Equipment

• Personal Protective Equipment - I will wear the required following PPE while on this site . Please see attachment

• I will wear the following Mandatory PPE while on this site

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• I will wear the following Task Specific PPE where and when required.

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• Site Wide Hazard Identification Tick appropriate Hazards you will encounter

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• Operative Sign off Signature. I will abide by Wall Steel rules for this site: duties of employees, site accident incident emergency procedures, permits to work, site housekeeping and task specific / RPE requirements. My Company Safety Statement has been communicated to me The risk assessment and method statement (RAMS) for the work I am going to do on this site has been communicated to me. I will notify my supervisor if my method statement does not cover my works on site. I will notify my supervisor of any unsafe conditions on site. I will have direct communication with supervisors. I will respect the welfare facilities on site The aim of the Wall Steel safety management system is to achieve a working environment which is free of work-related accidents and ill health and to preserve the lives and maintain the futures of all staff and others who may be affected by our activities. To achieve this, we need your help, without it we increase the risk of injury to ourselves and others as our duties are performed. I hereby declare that I will always work safely. I will report all accidents, incidents and near misses. I will comply with the project safety rules. I will comply with current H&S legislation and regulations.

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• Page 2 of 2 Issue no. 01 Date of Issue. 12/07/2024 Approver. David Joy Uncontrolled when printed

• Date and time of approval

  Date

• Approver's signature

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