Contractor sign-in

Welcome to Rutland Street Church. Please sign in before you start work. It takes about a minute.

Before you start
In an emergency call 111.
Find the nearest exit and the assembly point when you arrive.
Tell the church contact straight away about any injury, near miss or hazard.
Keep tools, cables and materials out of walkways and exits.
Do not leave hazardous substances or sharp tools where others can reach them.

First name *

Surname *

Your business *

Or write “Self-employed”.

Mobile number *

So we can reach you if something happens on site.

Email (optional)

What work are you doing? *

Where on site? (optional)

Will your work cause any of these? (tick any that apply) Working at height (ladders, roof) Hot work (welding, grinding, gas) Hazardous substances (paint, solvents, chemicals) Electrical work Could disturb asbestos Vehicles or heavy equipment Lots of noise or dust Confined spaces or digging

Anything else we should know about hazards? (optional)

Do you hold any licences or tickets this work needs? *

We do not ask for copies or numbers.

Yes No None needed for this work

Do you have current public liability insurance? * Yes No

When does it expire? (optional)

Will you be working where children are? *

The Children’s Act 2014 requires safety checks for people who work alone with children. If this is you, the church contact will talk to you first.

No Yes, with other adults around Yes, and I may be alone with children

I have read the information above, I know where the exits and assembly point are, and I will report any injury, near miss or hazard straight away.

We keep this only to keep everyone on site safe, for 12 months, and then delete it. Only the church’s safety team can see it. We never ask for your date of birth, address or ID.