Shared Welfare Certificate

Welfare Certificate Details

• Property address

• Bertram reference

• Client Reference

• Prepared by

Section to be completed by owner / occupier

As homeowner / occupier I give my permission for the staff of Bertram and their subcontractors to use the facilities indicated below -please answer yes, not or not applicable

• Sanitary conveniences

  Yes

  No

  N/A

• Washing facilities

  Yes

  No

  N/A

• Drinking water

  Yes

  No

  N/A

• Rest facilities

  Yes

  No

  N/A

• Details of other welfare issues / facilities

• Photo if applicable

  Media

• Signature

  Sign

• Date

  Date

Section to be completed by Bertram

The signature below indicates that the "responsible person" identified accepts for Bertram that should any person under the control of Bertram or their subcontractor's misuse any of the facilities provided that person will be dismissed from site and any costs incurred may be charged to the company and that permission to use the facilities may be withdrawn.

• Signature

  Sign

• Date

  Date