Appendix 5 - Contractors HSE Hand Book

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EMRILL PROCEDURE

HEALTH, SAFETY, SUSTAINABILITY & QUALITY

HEALTH, SAFETY & ENVIRONMENTAL HANDBOOK FOR SUBCONTRACTORS EM/IMS/PP034

HEALTH, SAFETY & ENVIRONMENTAL


HANDBOOK FOR SUBCONTRACTORS

Note: This document is ‘UNCONTROLLED WHEN PRINTED’

CONTRACT NAME:

CONTRACT NUMBER:

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HEALTH, SAFETY & ENVIRONMENTAL HANDBOOK FOR SUBCONTRACTORS EM/IMS/PP034

I the undersigned, hereby acknowledge receipt of the Health & Safety and Environmental handbook
for Subcontractors on behalf of:

Company:

Address:

Date:
In accepting this handbook, the Subcontractor agrees to co-operate with Emrill Group in the
implementation of the procedures set out and recognises that in no way does the handbook diminish
the Subcontractor’s existing or future statutory duties or contractual obligations.

The Subcontractor further agrees to communicate the information in the handbook to all persons
engaged on the Contract.

Name:
(block
capitals)

Signed:

Job Title:

Please remove this page from the handbook and return to: -

EMRIL Services LLC


P.O. Box No.: 38083,
Dubai, U.A.E.
Tel: 04 3089600
Contents
Fax: 04 3204969

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HEALTH, SAFETY & ENVIRONMENTAL HANDBOOK FOR SUBCONTRACTORS EM/IMS/PP034

1. Introduction 04

2. Legal Requirement 05

3. Subcontractors’ Responsibilities 07

4. Entry on To Site 08

5. Site Management 09

6. Health, Safety and Environmental Training 10

7. Accidents and Incidents 12

8. Welfare 12

9. Plant 13

10. Fire 13

11. Personal Protective Equipment (PPE) 14

12. Permit to Work (PPE) 14

13. COSHH 15

14. Working at height 15

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1.0 INTRODUCTION

This document has been prepared to aid and assist subcontractors and supply chain to work safely
and with due regard for the environment whilst working on Emrill Group property, or Emrill Group
controlled premises. The document aims to provide information on Emrill Group, its property, and its
expectations of subcontractors, related to health and safety and the environment.

Nothing in this document in any way relieves the subcontractor or modifies his legal and contractual
obligations to Emrill Group operation under the contract agreement be they expressed or implied.

It is the responsibility of the Subcontractor to communicate the content of this handbook to persons under his
control and to satisfy himself that it is strictly followed.
All references to “Subcontractor” shall where applicable be deemed to include all Subcontractors,
trade or works Subcontractors their employees or others under the Subcontractors control and who
have access to site. The self-employed and agency employed will for the purposes of this handbook
be regarded as ‘Subcontractors’

All references herein to “the company” will be deemed to refer to Emrill Group. Emrill Group is a provider of
integrated facility services and related property management services”. The subcontractor and his staff
should conduct their business in our client’s premises or property with particularly regard to the requirement
for completion of work method statements and risk assessments prior to the start of any specific risk
activities, and approval is sought from the client prior to the start of such activities, ensuring clear
site/contract area access, the correct use of power and hand tools and the minimisation of waste etc.

The company manages many buildings around the country in a wide range of industries. There may be local
safety rules and conditions or special hazards or restrictions, which may apply on sites and contracts. The
company undertakes to give you any health safety or environmental information in its possession that relates
to your work with us.

2.0 LEGAL REQUIREMENTS

2.1. Health & Safety


All Subcontractors must always comply with the provisions of, Federal Law 8-year 1980. OSHAD
code of practice, Dubai Technical Guidelines, Trakhees and any other legal body as applicable
This includes:
 Ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his
employees.
 The duty to conduct his undertaking in such a way as to ensure that persons not in his employment
are not exposed to risks to their health and safety.
 The duty to provide and maintain plant and systems of work, which are safe without risks to health.

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 The duty to decide to ensure safety and absences of risks to health in connection with the use,
handling, storage and transport of substances.
 The duty to provide a place of work that is safe and without risks to health and to provide safe
access to and egress from that place of work.
 The duty to provide a working environment that is safe and without risks to health.
 The duty to ensure that there are adequate welfare facilities and arrangements for his employees.

Accordingly, Subcontractors must take all necessary measures at their own cost to ensure the health and
safety of their own employees, others working on site, the public and persons using or entering the site
whether authorised or otherwise who may be affected by their activities.

The Subcontractors attention is particularly drawn to:

 Abu Dhabi Occupational, Safety and Health system framework OSHAD (CoP 1.0 to 55.0)
 UAE Fire and Life Safety Code of Practice – 2018
 Abu Dhabi Occupational, Safety and Health System framework OSHAD - OSH Roles,
Responsibilities
 Abu Dhabi OSHAD - Technical Guidelines
 Dubai Municipality Technical Guidelines
 UAE Federal Law 08 of 1980 on Regulating Labour Relations
 Order of Circulating hazardous substance, hazardous waste and medical wastes (Article 1) UAE
 UAE Ministerial Order # 32-year 1982

2.2 Environment

All Subcontractors must always comply with the provisions of all applicable environmental legislation
We require you: -

 To ensure, so far as is reasonably practicable, no nuisance is caused to the local community and
any building users, through the emissions of noise, dust, odours, grit, smoke, fumes (known
collectively as “Statutory Nuisances”.
 To prevent the pollution of the air, water resources and the contamination of ground.
 To store waste securely to prevent spillage and to ensure that waste is removed, treated or disposed
of by an organisation that is registered to do so.
 To prevent damage to wildlife and natural features

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The Subcontractor’s attention is particularly drawn to the below mentioned laws and the list is not
exhaustive.

2.3 Waste Management

 Abu Dhabi Occupational, Safety and Health system framework OSHAD – Hazardous materials (CoP
3.1)
 Abu Dhabi Occupational, Safety and Health system framework OSHAD – Management of Asbestos
Containing Materials (CoP 3.1)
 Abu Dhabi Occupational, Safety and Health system framework OSHAD- Waste Management (CoP
54.0)
 Abu Dhabi Occupational, Safety and Health System framework OSHAD- Environmental
Management (CoP 55.0)
 Code of Practice for the Management of Dangerous Goods Dubai Municipality 1997
 DM-PH&SD-P4-TG27 Guidelines for liquefied Petroleum Gas Cylinders
 DM-ED- GU01-EIA Technical Guideline No. 1 Environmental Impact Assessment Environmental
Impact Assessment

2.4 Water Quality

 UAE Ministry of Environment and water


 Green Building regulations & specifications Dubai Municipality
 Abu Dhabi Emirate Water Resources - 2009

2.5 Air Pollution & Noise

 Abu Dhabi Occupational, Safety and Health system framework CoP 14 – Noise Management
 Federal Environment Protection legislation 1993
 Federal Law No. 24 of 1999 for Protection and Development of the Environment

Note: - Only applicable on Dubai Ports, Palm Jumeirah & Customs free zones contracts
 Trakhees Government of Dubai Water Environment Regulations 1st Edition July 2010
 Trakhees régulation EN- 4.0 Air Environnent & EN – 12.0 Noise Control
 Trakhees Regulation CS – 5.0 Construction Safety Regulations for Environmental Nuisance
 Trakhees regulation FH – 5.0 Transport

Note: The following Regulations are for references only. These can be used for Continuous improvement of
the processes and Contractors/Companies are not held liable for any Non-conformities due to below
regulations.

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 The Management of Health and Safety at Work Regulations 1999


 The Manual Handling Operations Regulations 1992
 The Workplace Health, Safety and Welfare Regulations 1992
 The Personal Protective Equipment at Work Regulations 1992
 The Work Equipment Regulations 1998
 The Fire Precautions Act 1971
 The Reporting of Diseases, Dangerous Occurrences Regulations 1995
 The Control of Substances Hazardous to Health Regulations 1999
 The Noise at Work Regulations 1989
 The First Aid Regulations 1981
 The Construction (Design & Management) Regulations 1994
 Environmental Protection Act, 1990– Duty of Care
 Controlled Waste (Registration of Carriers and Seizure of Vehicles) Regulations 1991, as amended
by the Waste Management Licensing Regulations 1996 and the Controlled Waste Register of
Carriers and Seizure of Vehicles) (Amendment) Regulations 1998
 Water Resources Act 1991
 Water Industry Act 1991
 Groundwater Regulations 1998
 Proposals for Regulations to Control Water Pollution from Oil Stores in England
 Wildlife and Countryside Act 1981 (Amended 1985, 1991)
 The Town and Country Planning (Trees) Regulations 1999
 Hedgerow Regulations 1997
 Control of Pollution Act 1974 (Sections 60 and 61)
 Environmental Protection Act 1990 (Part III) and Noise and Statutory Nuisance Act 1993, the Noise
Act 1996
 Environment Act 1995

 The Environmental Protection (Controls on Substances that Deplete the Ozone Layer) Regulations
1996.

 Control of Asbestos in the Air Regulations 1990Control of Asbestos at Work Regulations 1987 etc.
 The Sulphur Content of Liquid Fuels (England and Wales) Regulations

 Environment Act 1995 (section 57) and the Contaminated Land Regulations (England) (2000)

 Water Resources Act 1991


 Road Vehicle (Construction and Use) Regulations 1986 (Amendments) Section 61(5) as amended
by the Road Vehicle (Construction and Use) (Amendment) Regulations 2000

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 Carriage of Dangerous Goods (Amendments) Regulations 1999

2.6 Subcontractors’ Roles & Responsibilities

It is the policy of Emrill Group that its operations are executed at all time in such a way as to ensure,
so far as is reasonably practicable, the health, safety and welfare of all its employees and all persons
likely to be affected by its operations including Subcontractors, non-employees of Emrill Group and
members of the public.
Subcontractors working for Emrill Group are required to co-operate with Emrill Group in discharging
its responsibilities and hence they must:

 Comply with any Emrill Group Health and Safety Arrangements and instructions issued by persons
enforcing our Policies.
 Comply with the rules set out in the Project HSE Plan.

 Subcontractors must have all appropriate professional training, licenses and certifications required
for the work being performed. Subcontractor’s team profile, key responsibilities of the team, training
records and copies of licenses, certifications are to be made available upon request.

 Ensure that the Site Manager / Superintendent or the Principal Subcontractor is informed of their
Health & Safety and Environmental risk assessment before commencing work on site and of any
changes in these assessments.

 Ensure that all employees likely to be affected by any risks identified by the risk assessment are
informed of the risks and the appropriate control measures to be taken.

 Ensure that any control measures (including provision of Personal Protective Equipment) are
followed by their employees and others under their control.

 Ensure that any other person likely to be affected by their operations is informed of the risks and the
measures necessary to remain unharmed.

 Prepare any specific method statement where required by the Site Manager. It must include all the
measures necessary to ensure that the operation can be carried out safely and must be submitted to
the Site Manager / Superintendent and agreed before work commences.

 Ensure that the Site Manager / Superintendent is informed of any matters which the Principal
Subcontractor must include in the health and safety file and the Environmental Action Plan.

 At all times co-operate with the Principal Subcontractor to enable him to carry out his statutory
duties.

3.0 Entry / Exit to & from Site

The Subcontractor must notify the Site Manager / Engineer / Superintendent of the persons
under his control prior to the contract commencement by completion of the subcontractors
Log (Appendix) and then each day notify the Emrill Group contact of any changes.

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Note: This does not apply to term Subcontractors whose employees have previously been agreed.

Other Subcontractors whose contract lasts more than 2 days are to maintain a site diary into which should
be entered:

 Names of persons on site


 Visitors to site
 Notable events
 Accidents
 The days start and finish times
 Registration numbers of vehicles on site

3.1 Subcontractors are permitted to park

 Parking is not permitted in any location other than a designated one.


 The Subcontractor must only use designated access routes for all staff and delivery vehicles.
 Areas where vehicles will operate are to be physically separated from pedestrian routes.
 Subcontractors are always to wear identity badges, when on Emrill Group premises.
 Parked vehicles are to be marked with the identity of the Subcontractors.
 Subcontractors must not obstruct any route, be it vehicular, pedestrian or emergency without first
obtaining the written permission of the Site Manager.
 Where a significant volume of deliveries is likely, the Subcontractor must pre-arrange times and
delivery points with his supplier. Delivery points are to be clearly identified by the Subcontractor.
 After completion of the day’s job, the Subcontractor needs to fill the site diary regarding status of the
job, clear the work area, dispose waste in designated locations and hand over Emrill Group
materials/tools/equipment used if any.
 A copy of the acknowledgement regarding completion of the job must be handed over to the Site
Manager / Personnel in charge. Any other relevant documents (test reports/records/assessment
records etc) must be provided.

4.0 Site Management / Site Rules

 Subcontractors must attend meetings as arranged and invited by the Site Manager.
 Subcontractors must not use Emrill Group owned tools, plant or equipment without the permission of
the Site Manager. Subcontractors must recognise that where such permission is granted that it does

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not relieve them of their liabilities for compliance with any statutory or common law requirements or
liabilities arising from such use.
 Subcontractors must satisfy themselves that the said tools plants or equipment are suitable for the
purpose for which they are to be used. Users must be properly trained at the Subcontractors
expense and be supervised. Defects must be reported to the Site Manager / Superintendent
immediately.
 The Subcontractor is to conduct himself, his staff, and the business in a professional and courteous
manner.
 The Subcontractor shall perform all work in a manner to prevent HSE incidents.
 Subcontractor to ensure TBT (Tool Box Talks) prior to the commencement of work.
 Notify immediately in case of any accidents/incidents/near miss to the site supervisor/HSE
coordinator/Manager.
 Subcontractor to ensure all risk assessments, environmental aspects, method
statements, relevant procedures/instructions is in place.
 Subcontractors to ensure adherence to PPE.
 Subcontractors to conduct routine inspections, checks on sites and promptly fix or safeguard
conditions and correct behaviours deemed to be a risk to HSE.
 Emrill Group will not tolerate written, spoken or implied abuse to anyone.
 Emrill Group has a policy of equality, regardless of colour, race, gender, sexual orientation, creed,
disability, ill health or age and requires its Subcontractors to be of similar opinion.
 Emrill Group will not permit the use by Subcontractors of any audio entertainment devices on its
premises, which includes those, designed for personal use, and those fitted to vehicles.
 The Subcontractor is to display his employees’ liability insurance certificate and any other statutory
documentation in a prominent place under his control.
 The Subcontractor will inform the Site Manager / Superintendent of all persons under the
Subcontractors control who are apprentices or trainees, to include work experience placements, and
of all personnel less than sixteen years of age.
 The Subcontractor must not bring to site any animal.
 The Subcontractor must agree the sitting of huts, skips, compounds etc. with the Site Manager /
Superintendent before they come to site.
 The Subcontractor is responsible for the security of the site under his control and all equipment and
fittings therein.
 The Subcontractor may use mobile unless otherwise informed by the Site Manager.
 The Subcontractor must familiarize and follow Emrill Group’s procedures/policies pertaining to
accidents/incidents/Don’t Walk By/emergency/alcohol/Permit to Work/COSHH and other relevant
policies and procedure.

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 Subcontractor must not misuse or cause any damage to property.

5.0 Health

Emrill Group operates a ‘no smoking’ policy within its premises. Subcontractors are expected to adhere to
this policy. Smoking is permitted external to buildings and in a staff smoking areas if provided.
The Subcontractor must make his own arrangements for Occupational Health Services.
Accident and Emergency services are
available at: Insert Hospital details)

A minor injuries unit is available during normal working hours at

Insert Hospital details)

Accidents must be reported on Emrill Group reporting form to the Site Manager / Superintendent without
delay. Copies of the form are available from your Emrill Group contact.

Subcontractors who are likely to work in ‘open air’ environments are reminded of the risks associated with
exposure to the sun. Emrill Group expects Subcontractors to assess such risks and to establish and enforce
control measures.

6.0 Safety and Environmental Training

It is the Subcontractor’s responsibility to ensure that all persons for whom he is responsible have
received induction, and job specific health and safety training so that they can carry out their work
safely. In addition it is the Subcontractor’s responsibility to ensure that all persons for whom he is
responsible have received sufficient training so they can carry out their work while minimising the
impact on the environment.
The Subcontractor is required to decide, before they start, for all persons working at the Contract to
attend a site-specific health, safety & environment induction-training course, approved by the Site
Manager. Subcontractor to ensure TBT (Tool Box Talks) are conducted prior to the commencement
of work.

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The Subcontractor will provide upon request written evidence in the form of certificates etc., of training given
to his employees. If this is not deemed sufficient the Subcontractor will, at his cost, arrange for suitable
training.
The Subcontractor, at his own cost, must release the persons for whom he is responsible to attend site
safety training sessions except where it is agreed with the Site Manager / Superintendent that any individual
employee has been adequately trained in the subject to which the training session relates, or the subject of
the training is not relevant to his work.
The Subcontractor must ensure that only trained and authorised persons are allowed to:
 Use and/or mount abrasive wheels use cartridge fixing tools.
 Operate technical equipment, plant or vehicles
 Work on high voltage systems
 Work on gas systems
 Work on water systems
 Work near asbestos materials
 Prepare or process or handle food
 Carry out lifting and handling tasks
 Use a display screen equipment workstation.
Records of Induction / Other relevant trainings /TBT / shall be maintained.

7.0 Accidents and Incidents

All accidents however trivial are to be reported to the concerned Supervisor / HSE Coordinator / Site
Manager and alternatively recorded on Emrill Group’s ‘‘Accident report form’’. This form is
obtainable from your Emrill Group contact.

All lost-time incidents must be reported to the Site Manager / Superintendent as soon as possible and Emrill
Group accident report form must also be completed.

All environmental emergencies, incidents or complaints are to be recorded on Emrill Group Incident Report
Form.
Mitigation measures must be carried out to minimise the impact of any environmental incidents. This incident
must be reported immediately to the Site Manager
Any complaints that are received must be directed to the Site Manager.
For more details EM-IMS-PP009 (rev9) Accident Incident Reporting & Investigation Procedure can be
referred.

8.0 Welfare

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It is the responsibility of the Subcontractor to ensure that suitable welfare and First
Aid facilities are provided.
All First Aid and welfare facilities must be kept in a clean and tidy condition. Tools and/or other materials
must not be stored in welfare facilities.
The Subcontractor may use catering facilities provided on any of its sites subject to following local
conditions. All working clothing must be removed before entry into such areas.
The Subcontractor may use sanitation arrangements provided for public use at any of its sites and,
additionally, other facilities as agreed with the Site Manager. The Subcontractor must not use any facilities
unless previously agreed. The use of Emrill Group catering and sanitation facilities is a concession that
could be withdrawn at any time in the event of justifiable complaint by Emrill Group employees.

9.0 Plant

All plant and equipment owned or hired by the Subcontractor must be in and maintained in a safe
working condition before and during use on site.
Test and Examination Certificates, insurance documentation and registers are to be available on site
for all lifting appliances and hoists before they are used.
Trained, competent persons must only operate plant.
The carrying of passengers on tractors, trailers, dumpers or any other site vehicles unless so
designed is forbidden, and all such vehicles must be fitted with a notice to this effect.
All plant and equipment brought on site by Subcontractors must be such that the emission of noise is
as low as reasonably practicable. Any special requirements laid down in the “Conditions of Contract”
must be adhered to.
Portable or semi-portable electric tools and temporary lighting must not be more than 110v, centre
tapped, 55v to earth, without specific permission of the Site Manager
Portable or semi portable appliances, temporary lighting and extension leads are to be subject to a
satisfactory appliance test and are to bear a label as proof of test.

10.0 Fire

Subcontractors must observe local fire safety arrangements and comply with any Site Fire Safety
Procedures. These will be notified at site induction.
Temporary accommodation units must not be installed inside buildings under construction without the
agreement of the Site Manager / Superintendent and any such buildings must comply with the Joint Code of
Practice – Fire Prevention of Construction Sites.
Suitable firefighting appliances must be provided, and a fire alarm system where specified in the above code.
All fire exits must be suitably marked and kept free from obstruction.
A Fire Certificate should be applied for where appropriate.
Where required by the Site Fire Safety Plan a Permit to Work system for hot work must be adopted and
agreed with site management.
Emrill Group may institute a total non-smoking policy on any part of the site at any time it considers it
necessary to reduce the risk of fire. All Subcontractors must then comply with this policy.

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Subcontractors will not attempt to extinguish a fire beyond the use of one extinguisher, and then only if
competent and confident to do so.
Fires extinguished locally by Subcontractors must be reported on Emrill Group accident/incident reporting
form to the Site Manager.
Subcontractors are not to obstruct or obscure any fire exit route or any fire safety equipment provided for fire
safety without the written permission of the Site Manager.

11.0 Personal Protective Equipment (PPE)

 Subcontractors employed on overhead works and window cleaning on high level contracts must ensure
that the persons for whom they are always responsible wear head protection unless the Site Manager /
Superintendent has designated otherwise. This includes scaffolders.

 If a Subcontractor is carrying out work that creates noise more than the second action level, he must
clearly identify a suitable ear protection zone. He must supply suitable ear protection and ensure that this
is worn whenever a person enters any ear protection zone.

 Where a risk assessment indicates a risk of foot injury, which cannot be, otherwise controlled then the
Subcontractor must supply at his own cost suitable foot protection for his employees and must ensure
that it is worn.

 The Subcontractor must supply his employees and manage the wearing of Personal Protective
Equipment whenever a risk assessment has shown this to be necessary.

 The Subcontractor shall provide suitable and adequate storage facilities for any PPE supplied.

12. Permit to Work (PTW)

A permit to work is a control procedure, which may be issued for virtually any work activity but has usually
been reserved for what would be classified as high-risk activities, tasks or processes. The procedure is a
formalization of assessed and implemented controls and limitations, designed to provide a safe system of
work. The permit is issued, and returned to on completion of the work, by an authorized person.

Types of PTW:

1. General Permit to work: Issued for general works


2. Hot work Permit: Issued for the welding, grinding, cutting, works etc.
3. Confined space work permit: Issued for working in water tanks, sewerage pits, silos etc.
4. Permit to work at height: Issued for working on MEWP, Scaffold, Cradle, Rope access & Ladder
5. Electrical work permits: Issued for working on high voltage electrical equipment.
6. Excavation work permit: Issued for digging
All Subcontractors shall adhere to Emrill Group’s PTW system.

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13.0 COSHH (Control of Substances Hazardous to Health)

Many activities involving toxic, flammable and corrosive substances are carried out at sites. All the
Subcontractors shall comply with Emrill Group COSHH Policy.

The first essential with any substance is to ensure that information on the hazards and precautions
associated with it are obtained from the manufacturer or supplier. An assessment of the risks involved in its
use must then be carried out to determine necessary control measures.

All necessary information, instruction and training must be given to those using hazardous substances and
checks must be made to ensure that control measures are both implemented and adequate. For further
guidance see COSHH and Risk Assessment Standards referred in Emrill Group’s HSE manual.

14.0 Working at Height

Following checks to be made for working at height safely:


1. Provide fall protection to personnel climbing at height, use full body harness, carry tools in pouches or
separately.

2. Erect proper scaffold by qualified person, provide proper supports, do not over load scaffold boards, and
secure loose materials.

3. Position ladder with correct angle to the wall. Secure the ladder at top and bottom.

4. Use fall protection, use certified buckets, do not carry loose materials and tools, do not allow person with
vertigo climb up.

Following checks to be made for safe use of scaffolding:

1. Erect the scaffolding to the required standards.

2. Use fall protection while climbing on scaffolding.

3. Secure the fall protection to a strong point in scaffold.

4. Do not store materials on the scaffolding board, which are not required for the job

5. Use proper and approved materials for the erection of scaffoldings. Tie the scaffold properly to ensure
the stability of the structure. Ensure the erection is done by qualified scaffolders and supervised by a
competent person. Erect the scaffolding on a firm base.

6. All checks / scaffold tags / TBT’s shall be made prior to the commence of work

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SUBCONTRACTOR LOG

Contract Name:

CONTRACT NUMBER:

SUBCONTRACTOR:

SUBCONTRACTOR’S ADDRESS:

SUBCONTRACTOR’S EMERGENCY TEL. NO.:

CONTRACT DURATION:

PERSON IN CHARGE OF SITE/CONTRACT:

SITE CONTACT FOR HEALTH & SAFETY ISSUES:

SITE CONTACT FOR ENVIRONMENTAL ISSUES:

DETAILS OF SUB SUBCONTRACTORS:

NAMES OF PERSONS LIKELY TO BE ‘ON SITE’:

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EMRILL PROCEDURE
HEALTH, SAFETY, SUSTAINABILITY & QUALITY

HEALTH, SAFETY & ENVIRONMENTAL HANDBOOK FOR SUBCONTRACTORS EM/IMS/PP034

NAMES OF TRAINEES, INEXPERIENCED


PERSONS OR PERSONS AGED UNDER 16:

ANY FURTHER INFORMATION:

SIGNED BY: DATE:

BLOCK AUTHORISED PERSON


CAPITALS

Rev 006 21/04/2021 Page 17 of 17

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