LEVISMAR FORMWORK AND GROUNDWORKS LTD

INDUCTEES DETAILS SITE:

 NAME (BLOCK CAPITALS):

 YOUR CONTACT ADDRESS:
 YOUR PHONE NO:
 ARE YOU UNDER 18 YES /NO
 NAME & PHONE NO OF NEXT OF KIN:
 EMPLOYED BY (COMPANY NAME) :
 ARE YOU SUB-CONTRACTING FOR A SUB-CONTRACTOR OF LONDON BUILDING COMPANY
YES/NO
 COMPANY CONTACT PHONE NO:
TRAINING TYPE TRAINING CARD NO EXP DATE
 CSCS TRAINING:
 SAFE PASS NO
 FIRST AID TRAINING YES/NO
 MANUAL HANDLING TRAINING
 PASMA TRAINING:
 ABBRASIVE WHEELS
 OTHER PLEASE STATE

When you sign this form, you are also declaring:

 That you have been inducted on health and safety for the above project and understand your duties and
responsibilities on the project. You have no objection to your information being stored on file.

 That your own companies Health & Safety Statement including the risk assessment and method statement
has been effectively communicated to you and it’s and contents fully understood.

 Acknowledge that failure to comply with the foregoing procedures and safety rules may result in
disciplinary procedure or instant dismissal.

 That you are medically fit to carry out your work duties and that you do not have any condition that could
affect the safe use of machinery/equipment or while working at heights etc. (Persons are required to
disclose any medical or other condition which may affect their safety and the safety of others. This
information is treated in a confidential manner by London Building Company once declared)

 That you will take full responsibility to ensure that your CSCS/safe pass and other required certification is
renewed on time to avoid expiry or unauthorised use of plant and equipment.

 You are now aware of the site emergency procedures, exit routes, fire assemble point/s. Signing in and out
is compulsory and without exception.

 You confirm you have been advised of the Coronavirus symptoms during the induction and you agree to
inform your line Manager/Supervisor should you show any of the symptoms whilst on site and that you will
not attend site if you have any of the symptom’s prior to attending site.

SIGNED BY: ______________________________ DATE: ___/____/ _____

TO BE SIGNED BY INDUCTOR :
___________________________ DATE: ___/____/ ____
LEVISMAR FORMWORK AND GROUNDWORKS LTD