IGC3 The Health and Safety Practical Application

Candidate and course provider declarations:

For completion by the candidate:
I declare that the work submitted for this practical application assessment i.e. the completed
observation sheets and the report to management, is my own work. I recognize that
contravention of this statement constitutes malpractice and may result in my being subject to
the penalties set out in the NEBOSH Malpractice policy.
Name (Print) ________________________________
Signature

________________________________

Date

______/______/________

For completion by a course provider representative

(e.g. internal practical assessor)
I declare that the work marked is identical to that received from the candidate. I recognize that
contravention of this statement constitute malpractice and may result in my being subject to
the penalties set out in the NEBOSH Malpractice policy.
Name (Print) _________________________________
Signature

_________________________________

Date

______/______/________

For completion by the course providers internal practical assessor:

I declare that I have marked this work and am both qualified and approved by NEBOSH to do so.
I recognize that contravention of this statement constitutes malpractice and may result in my
being subject to the penalties set out in the NEBOSH Malpractice policy.
Name (Print) __________________________________
Signature

__________________________________

Date

______/______/________

NB: This declaration must be completed in full, submitted and retained with the candidates
script.
If this declaration is not submitted the candidates result may be declared void.