Health & Safety Questionnaire

Your Name:MIRCEA FLORENTIN FLORESCU Client Name: TR-03 SERVICES LTD

Site Address: ARDA ROAD LONDON UK. N9 0BD. ENFILD

Start Date: 02.03.2020 Duration: (if known)

TR03 provides health & safety manuals for its subcontractors, which are sent with their
registration documents, and must be read before completing and signing the final declaration.

By signing the final declaration, you confirm you have had access to and have read TR03's
Customer health and safety manual.

Section A (Please delete/cross through)

1. Have you read and understood the client’s fire evacuation procedure?

Yes / No

2. Have you read and understood the accident and dangerous incident reporting
procedures of the client?

Yes / No

3. Have you read and understood the client’s health and safety policy?

Yes / No

4. Do you know the location of the first aid centre or your nominated first aider?

Yes/ No

5. Have you read and understood applicable workplace risk assessments?

Yes / No

6. Do you have the required technical knowledge and training to carry out the work in
questions?

Yes / No

Registered Office: 45 Carlton Road, Erith, England, DA8 1DR

Company No: 10054788
Tel No: 013 2240 9530; Mob No: 077 2584 5038; E-mail: office@tr03ltd.co.uk
Section B (Please delete/cross through)

1. Do you have the appropriate personal protective equipment e.g., goggles, ear defenders,
hard hot, boots?

Yes / No

2. Is the personal protective equipment suitable and sufficient for your needs?

Yes / No
3. Is the machinery upon which you are working properly guarded?

Yes / No

4. Have you read and understood any applicable work procedures or permit to work
system?

Yes / No

5. Are you satisfied that your working environment is safe in so for as is reasonably
practicable?

Yes / No

Thank you for your taking time to complete this questionnaire. If you have answered
“No” to any of the above questions, or if you have any queries, please contact TR-03 Services
Limited on 013 2240 9530 or e-mail office@tr03ltd.co.uk before you return this questionnaire.

Registered Office: 45 Carlton Road, Erith, England, DA8 1DR

Company No: 10054788
Tel No: 013 2240 9530; Mob No: 077 2584 5038; E-mail: office@tr03ltd.co.uk