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Health and Safety form

Please complete this form as best you can to help us work safely on your premises. Thank you.

 

    YOUR DETAILS (required)

    Customer Name

    Your Email

    SITE SAFETY (required)

    Is there a Health and Safety Law poster on site?

    YesNoDon't know

    Health and Safety Law Poster location:

    Are you satisfied the site has no unavoidable trip hazards and that access and movement around the site is unobstructed?

    YesNoDon't know

    Are stairways, fire escapes and high level openings provided with suitable handrails and guarding?

    YesNoDon't know

    COVID-19 (required)

    Please confirm that you will inform us immediately if there is possible or confirmed coronavirus (COVID-19) case at your premises.

    YesNo

    ACCIDENTS AND FIRST AID (required)

    Is there a First Aid box on site?

    YesNoDon't know

    First Aid box location:

    In the event of an accident, Green Mop has its own accident reporting procedures. If you have your own accident reporting process for site visitors or contractors, please give the name and email address of the person responsible.

    Accident reporting - name and email address:

    GAS AND ELECTRICAL SAFETY (required)

    Are periodic checks and tests undertaken on electrical and gas installations by a competent person?

    YesNoDon't know

    Are electrical safety checks made on portable appliances?

    YesNoDon't know

    ASBESTOS (required)

    The Control of Asbestos at Work Regulations 2006 require the management of asbestos in non-domestic premises appropriate action regarding faults found.

    Are arrangements in place to monitor and review asbestos or asbestos containing materials?

    YesNoDon't know

    Is any asbestos or asbestos containing material present at your premises?

    YesNoDon't know

    If asbestos is present at your site, please give details:

    FIRE SAFETY (required)

    Is there an emergency procedure for raising the alarm and evacuation in the event of a fire?

    YesNoDon't know

    Do you have a Fire Risk Assessment for your premises?

    YesNoDon't know

    Are Emergency Escape Procedures displayed in your Premises? If so, please state where:

    PLEASE EMAIL US COPIES OF YOUR EMERGENCY PROCEDURES AND FIRE RISK ASSESSMENT.

    YesNo

    OTHER RELEVANT INFORMATION

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