HEALTH AND SAFETY COMPLIANCE DECLARATION –

SPECIALIST

I hereby declare that the that the applicant has a Safety Statement in the format outlined at http://www.hsa.ie/eng/Publications_and_Forms/Publications/Safety_and_Health_Management/Guidelines_on_Risk_Assessments_and_Safety_Statements.pdf which will be provided on request and that all of the requirements listed below are addressed in the Safety Statement as is the evidence relating to the minimum standards also listed below which have been met. If the requirements and minimum standards have not been addressed in the Safety Statement separate evidence is to be provided on request which demonstrates that such requirements and minimum standards have been met.

Requirements	Minimum Standards
a copy of our current general health and safety policy;	a general Health and Safety policy document appropriate to a Health and Safety led Construction Management role;
an outline of our management organisational structure with regard to allocation of duties, delegation of responsibilities, etc., in relation to Health and Safety;	the relevant management organisational structure document indicating the duty holders responsible for Health and Safety;
copies of standard forms used for method statements and risk assessments as part of our duties under the Safety, Health and Welfare at Work Act 2005;	a standard method statements (relevant to projects of a similar size, nature and complexity) covering all stages of the construction project life cycle from initiation to project completion;
details of arrangements for continuing training of personnel in Health and Safety, including personnel who would be employed on the project;	evidence of training arrangements in place appropriate to the size and complexity of the work. (This must include specific Health and Safety training);
details of the company’s procedures for disseminating up-to-date developments on health and safety issues;	evidence that there is an adequate organisational structure in place within the company to facilitate the dissemination of up-to-date developments on health and safety issues.
details of the company’s arrangements for the co-ordination of information between the different contractors, suppliers and designers involved in a project;	evidence that there are adequate arrangements in place for the coordination of information between Contractor and PSCS with an adequate mechanism in place that tracks and records delivery and receipt of information distributed.
details of the methodology for the dissemination of health and safety information for the construction stage on this or equivalent projects;

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