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© 2017 CLUBWIFI LTD

67 Fore Street,

Chudleigh, Devon.

TQ13 0HT

Tel - 01626 270140        Email sales@clubwifi.co.uk

ClubWifi Health & Safety Form
 

ACCIDENT WAIVER AND RELEASE OF LIABILITY VISIT FORM

 

 

I hereby assume all of the risks of participating in any/all activities associated with this event, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. 

 

I certify that I am physically fit, am sufficiently prepared and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation. 

I acknowledge that this Accident Waiver and Release of Liability Form will be used by ClubWifi Ltd and that it will govern my actions and responsibilities.

 

  1. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Clubwifi Ltd and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; 

  2. INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. 

I acknowledge that ClubWifi Ltd and their Directors, Officers, Representatives, and Agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. 

Contractors Responsibilities :

  • All contractors must sign in at site reception, report to ClubWifi representative onsite and wear the correct uniform and high visuals at all times

  • All contractors must sign the contractor control form before work can commence

  • Any working operation, which a contractor carries carry out on the client premises must meet all the legal requirements.  If in doubt you may contact the Health and Safety Officer

  • A contractors’ work area may on agreement be fenced, roped or taped and have no admittance notices displayed.  When fenced the area will be the contractors’ responsibility and not ClubWifi Ltd responsibility

  • Contractors must provide adequate supervision of their workforce at all times

  • Contractors must be suitably and sufficiently trained for the task they are to perform

Copies for proof of certification from a governing body must be given to the Operations Manager for:

  • Any demolition or excavation work

  • Hot work

  • Work on live electrics

  • Working at heights

  • Confined space

  • Working on the roof

  • And any other work deemed hazardous

Tools & Equipment:

  • All equipment or tools brought on to ClubWifi Ltd client sites by contractors must be of sound construction and should meet the statutory requirements applicable to these tools or equipment

  • A contractor can not use any of ClubWifi Ltd tools, machinery or equipment unless authorised to do so by the Operations Manager, Networks Manager or his representative

  • ClubWifi Ltd employees are prohibited from using contractors tools, machinery or equipment. Except when assisting the contractor with the permission of the Operations Manager or Networks Manager

  • All lifting equipment must carry a current certification, which should be available for inspection on request by management. The lifting equipment must also comply with ClubWifi Ltd Company standards

  • All portable electrical equipment must comply with ClubWifi Ltd Company standards and conform to the 1989 Electricity at Work Regulations

  • All ladders used must be of type 1 or 2 and not domestic ladders. Ladders are to be in a safe condition and are used in accordance with company standards

  • The erection of scaffolding must be carried out by qualified scaffolders and must comply at all times with statutory legalisation including those relating to periodic inspection

  • Scaffolding must provide safety for persons using it and safety of those passing beneath it

Protective Equipment:

  • Contractors must provide their employees with safety equipment and protective clothing

  • Contractors must wear hearing protection in noise hazard areas and to be instructed on how to wear the hearing protection

  • It is ClubWifi Ltd Company policy to wear safety glasses in designated areas. Contractors must wear the safety glasses failure to do may result in termination of the contract

  • It is ClubWifi Ltd Company Policy to wear Safety Footwear in designated areas. Contractors must provide safety footwear for their employees before entering the designated areas

  • It is ClubWifi Ltd Company Policy to wear Safety Headwear in designated areas. Contractors must provide safety Headwear for their employees before entering the designated areas

Fire:

  • Contractors are advised to take notice of the fire evacuation procedure on the clients site, and of the assembly points you should report to in the event of a fire

  • "No Smoking" is enforced on all ClubWifi Ltd sites

COSHH:

  • Contractors must not introduce any hazardous substance without the prior approval of the Health and Safety Officer onto ClubWifi Ltd sites

Noise:

  • Contractors are reminded to control noise levels of any activities carried out on site and must not expose anyone, to noise levels above 85dB(A)

 

Accidents:

  • All accidents must be reported to ClubWifi Ltd.  An accident means any injury to personnel, damage to property, or event, which may have led to such an occurrence

  • The company may wish to investigate all accidents that occur on its sites and expect the co-operation of the contractor and his employees in ascertaining the true cause in an effort to prevent a similar accident

  • Accidents and dangerous occurrences must be reported in accordance with Report of Injury, Disease or Dangerous Occurrences Regulations 1995

First Aid:

  • In the event of an accident First Aid see the sites first aider

  • Contact the Reception and the nearest appointed first aid person will be notified

Breaches of Rules:

  • The contractor acknowledges that any breach of this Code of Practice, or any relevant provision by contractors/sub-contractors or their employees shall be deemed to be fundamental breach of contract. Which entitles the company to terminate the contract without prejudice to any right to the company to claim damages in respect of the breach of the Code of Practice

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organisers, and assigns.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I GIVE FULL CONSENT.