HEALTH AND SAFETY COMPLIANCE DECLARATION – Specialist as Designer

I hereby declare 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.

The following evidence is to be provided at the appropriate time………	.and.	………..the minimum standard is …………
a copy of our current general health and safety policy;	a general Health and Safety policy document appropriate to the relevant design discipline
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 risk assessments as part of our duties under the Safety, Health and Welfare at Work Act 2005;	standard risk assessment forms (relevant to projects of a similar size, nature and complexity) covering all stages of a project life cycle from early design stage to project completion;
details of arrangements for Continuing Professional Development (both relevant to the design discipline and health and safety) of personnel, including personnel who would be employed on the project;	evidence of CPD training arrangements in place (for Designers) appropriate to the size and complexity of the work;
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 designers and technical disciplines involved in a project;	evidence that there are adequate arrangements in place for the coordination of information between contractor’s designers with 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 design and construction stage on this or equivalent projects;	evidence of adequate structured procedures relevant to the size and complexity of the project to ensure that the specialist’s design role is clearly demonstrated and that health and safety information is disseminated to the relevant parties and appropriate action taken.

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