HEALTH AND SAFETY DECLARATION – SPECIALIST/SPECIALIST WITH DESIGN INPUT

APPOINTMENTS

[All sections to be completed in BLOCK CAPITALS]

In relation to	Applicant Entry [Project Title]
We	Applicant Entry [Applicant's Business Name]
Proposing to act as	Applicant Entry [ Required Role: Specialist/Specialist with Design Input]

on the above project hereby declare the following:

Health and Safety management within the practice is the responsibility of:

Applicant Entry: [Name of Person responsible

We confirm that each member of staff is aware of his/her responsibilities under the Safety, Health and Welfare at Work Act 2005 and the Safety Health & Welfare at Work (Construction) Regulations 2013.

In particular we are familiar with our general duties as contractor as outlined in Part 3 Regulations 24-29 of the Safety Health & Welfare at Work (Construction) Regulations 2013; also with the specific duties enumerated in Parts 4-14, Regulations 30-105 of those Regulations and Schedules 1-6 of those Regulations. We are aware of and will take into account the general principles of prevention as enumerated below when carrying out design construction work associated with the project and undertake to liaise with, communicate and cooperate with the PSDP and the PSCS in their roles.

GENERAL PRINCIPLES OF PREVENTION APPLICABLE TO CONTRACTOR The purpose of the General Principles of Prevention is to provide a framework within which account is taken when identifying hazards in the risk assessment required under section 19 of the Safety, Health and Welfare at Work Act 2005. The avoidance of risks The evaluation of unavoidable risks The combating of risks at source The adaptation of work to the individual, especially as regards the design of places of work, the choice of work equipment and systems of work, with a view to alleviating monotonous work and work at a predetermined rate and to reduce their effect on health The adaptation of the workplace to technical progress The replacement of dangerous articles, substances or systems of work by non dangerous articles, substances or systems of work. The giving to collective protective measures priority over individual protective measure The development of an adequate prevention policy in relation to safety, health and welfare at work, which takes account of technology, organization of work, working conditions, social factors and the influence of factors related to the working environment. The provision of appropriate training and instruction to employees.

We are aware as contractors of our obligations under Section 17 (3) of the Safety Health & Welfare at Work Act 2005 to ensure so far as is reasonably practicable that the project ‘is constructed to be safe and without risk to health and that it complies in all respects, as appropriate, with the relevant statutory provisions’.

We confirm that all staff have received, read and will apply the Safety, Health and Welfare at Work (General Application) Regulations 2007, the Guide to the Safety, Health and Welfare at Work (General Application) Regulations 2007, and the HSA Guidelines on Risk Assessments and Safety Statements available at: http://www.hsa.ie/eng/Publications_and_Forms/Publications/Safety_and_Health_Management/Guidelines_on_Risk_Assessments_and_Safety_Statements.pdf

Where the role required is Specialist/Specialist with Design Input risk assessments will be carried out and maintained on the job file.

We confirm that in our opinion this declaration is deemed to satisfy our obligations in relation to the following areas given the scope and nature of the proposed works:

Health and Safety Policy and Organization;

Arrangements;

Competent Advice;

Training and Information;

Individual Qualifications and Experience;

Monitoring, Audit and Review;

Workforce Involvement;

Accident/Incident Reporting, Review;

Sub-consulting Procedures;

Hazard Management and Risk Assessment; and

Health and Welfare.

In relation to enforcement actions, legal proceedings accidents, fatalities or incidents associated with the discharge of our duties as Specialist/Specialist with Design Input (whether the relevant discipline is the subject of this declaration or not) over the last three years

Applicant Entry: There have been none. / See details attached

We confirm that in our opinion our organization is competent and adequately resourced to fulfil its obligations under the Safety, Health and Welfare at Work Act 2005 and that our organization has adequate resources to fulfil the role of Specialist/Specialist with Design Input as stated above.

SIGNATURE:	DATE:
APPLICANT NAME:	Entry [block letters]
TITLE:	Entry [block letters]

Under the Safety, Health & Welfare at Work (Construction) Regulations 2013, the term ‘contractor’ applies to main contractors and sub-contractors alike.