Title Page
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Site conducted
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Conducted on
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Prepared by
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To be renewd/reviewed (12 months from date of completion)
Contractor Details
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Company Name
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Nature of work undertaken
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Contractor Full name
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Job Title/Role
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Photograph of the contractor or photo of their ID
Information/Instructions
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Have you explained to the contractor where the fire assembly point is for your scheme?
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Have you explained to the contractor what to do if they discover a fire?
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Have you explained to the contractor what to do if they require first aid?
Site Specific Hazards
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Fire arrangements and what to do if there is a fire (discuss)
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Hazardous Substances discussed (COSHH)
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Violence and Aggression discussed
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Electricity (inc power failure)
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Legionella
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Are there other contractors working on-site
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Slips, trips and falls (discussed)
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Explain what to do if a needle is found
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Is the contractor working at height?
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Will the contractor be producing any waste?
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Have you discussed how the waste will be safely disposed of?
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Will the contractor be working in any loft spaces?
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Explain to the contractor about closing internal doors within loft spaces when work is complete
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Explain to the contractor to ensure that any fire stopping is put back in place if it has been moved in order for them to carry out their work
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Explain to the contractor that all rubbish from their work must be disposed of correctly and not left in any loft spaces
Additional Items to discuss
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Smoking
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Refreshments (food and drinks)
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Car Parking
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Other items discussed
Induction Sign off
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I confirm that I have read, understood and will abide by the Contractors Induction Record. I will also ensure that I disclose any new hazards introduced to the premises while undertaking work to the Manager or other staff members.
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Contractor Signature
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Midland Heart staff member signature
