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NEW STARTER u

2 YEAR REFRESHER u

CHANGED COMPANY u

LOST BADGE u

OTHER……………………

CONTRACTOR REGISTRATION FORM NON FACTORY BASED CONTRACTORS
(Yellow ID Badge) 1)
THIS SECTION IS TO BE COMPLETED BY THE CONTRACTOR

COMPANY NAME………………………………………………………………………………………………………….….…… COMPANY ADDRESS………………………………………………………………………………………………………..…… SURNAME………………………………..…………… FORENAME………………………………………….………………. DATE OF BIRTH………………….…….….…N.I.NUMBER

2)
a)

THIS SECTION IS TO BE COMPLETED BY THE CONTRACTORS COMPANY MANAGER I CONFIRM THAT THIS PERSON:Is over the age of 18…………………………………………………………………………YES
If the office based contractor is 16 but under 18 years of age [young person]. The Mars host Manager must complete a ‘Risk Assessment’ before commencement of work. This is a legal requirement. Contact the Mars HSE department for approval of Risk Assessment and authorisation.
HSE Manager/Technician SIGN …………….…………………………………………………..DATE………………………………

NO

b) c) d)

This person is in good health and is not suffering from any condition that could be hazardous to Mars food product or employees…………………………... This person has been made aware of and trained in particular hazards he/she may encounter whilst carrying out any work activities on the Mars site…..

YES

NO NO NO

……….YES YES

Has read the ‘You & Mars’ booklet for office based Contractors………………….

I AM NOT AWARE OF ANY REASON WHY THIS PERSON SHOULD NOT PROVIDE A COMPETENT SERVICE FOR MARS.
CONTRACT COMPANY MANAGER - PRINT NAME ……..………………………..…………….. SIGN …………………………………………………

POSITION IN THE COMPANY …………….…………………………………………………..DATE…………………………………

(Falsifying any information may result in YOU being liable, in the event of a health, safety, hygiene, environmental incident)

3)
a) b)

THIS SECTION IS TO BE COMPLETED BY THE MARS ASSOCIATE RESPONSIBLE FOR THE CONTRACTOR Has completed the department induction………………..……………………………... YES Has completed a non factory ‘Safety Awareness’ questionnaire……………………….. YES NO NO

I CONFIRM THAT THE PERSON NAMED IN SECTION (1)

MARS HOST MANAGER

PRINT NAME…………………..………………………….SIGN……………..……………….………………DATE……..…………..

4)
a) b) c) d)

THIS SECTION TO BE READ & SIGNED BY THE CONTRACTOR
I confirm that I have been given the Mars Safety Induction. CONFIDENTIALITY AND IP-RIGHTS I acknowledge that Mars has confidential information, (which includes trade secrets, know how and any information relating to the Mars business) the confidentiality of which it wishes to maintain. I hereby agree that I shall not, without the prior written consent of Mars, disclose to any third party any confidential information that I may receive, obtain, discover or otherwise come into contact with while working (on the Mars site). I agree that I shall not use any confidential information without the prior, written permission of Mars. I agree that any intellectual property or related rights conceived, invented or developed in the course of my contract with Mars shall be the exclusive property of Mars.
Yellow badge contractor registration form.2007 Mars HSE Department

CONTRACTOR PRINT NAME………….…………………………………….SIGN…………………..…………….………………DATE………..………