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Supplier Application
Full Name
Mobile Phone Number
Email Address
Home Address
Date of Birth
Emergency Contact Name & Telephone Number
Trading Entity
(For Ltd Companies) Trading or Company Name
UTR Number
National Insurance Number
Bank Sort Code
Account Number
Trade
Health & Safety Information
CSCS Card
CSCS Expires
CSCS
SSSTS
SSSTS Expires
SSSTS
Have you been involved in any reportable accident in the last 3 years?
*
No
Yes
Do you have access to a full range of PPE required for your tasks?
*
No
Yes
SMSTS
SMSTS Expires
First Aid
First Aid Expires
Forklift Licence
Forklift Expires
SMSTS
First Aid
Forklift
Have you ever been prosecuted or served a formal notice by the HSE?
*
No
Yes
Are all your tools/equipment fit for purpose and fully maintained?
*
No
Yes
Are any vehicles you use for work insured taxed and fully maintained?
*
No
Yes
I accept that I will allocate suitable time to attend your company induction. (Please sign below)
Clear
H&S Policy Rewiewed and Agreed to (Please Sign Below)
Clear
I accept that I will complete a health surveillance questionnaire on first joining your organisation. (Please sign below)
Clear
RAMS Rewiewed and Agreed to (Please Sign Below)
Clear
Submit
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