Contractor Declaration/Acknowledge Form

The Purpose of the Contractor Declaration/Acknowledge Form

The objective and intent of this under discussion document is to ensure that the Company and the Contractor comply with all relevant statutory requirements regarding occupational safety, health, welfare and environmental legislation and that procedures are in place to achieve this objective and safeguard the safety, health and welfare of all persons/employees/workforce on or about the project and protect the environment.

This document, of necessity, covers and highlights legal requirements in brief only. Contractors must, therefore, refer to the full text of all relevant legislation and regulations. The Company (your organisation name) accepts no responsibility for any errors or omissions herein.

The First Part of the Declaration/Acknowledgement Form-Employees/Contractors

I / We hereby certify that:

All persons, employees and sub-contractors used by us have the necessary training, qualification and competency to carry out all work safely and satisfactorily, without placing themselves, (Your Company Name) staff, visitors or any other person on (Your Company Name) premises at risk of injury.
None of our employees, agents or other people under our control is employees of (Company).
All work/activities/tasks will be carried out in a safe competent manner in compliance with, and all processes, plant, equipment and materials used or supplied will comply with, all applicable Federal and / or State legislation and associated regulations and all relevant (your business operating state/country) Standards and National / State Codes of Practice

The Second Part of the Declaration/Acknowledgement Form-Employers

I / We agree to:

Pay for or make good all damage caused by us or any employees or subcontractors engaged by us whilst carrying out work for, or on the premises of (Company Name).
Accept responsibility under the Workers Rehabilitation and Compensation Act (your country applicable Act) for any accident, injury or illness that may be caused to any of our employees and ensure that other persons under our control who are not employees are either covered by the Act or have personal accident/disability insurance cover as appropriate, whilst carrying out work for, or on the premises of (company).
Abide by any induction, security procedures, notifications and safety rules including drug and alcohol testing (received in verbal or written form, now or in the future) about all work we carry out for (company).
Immediately advise (company) management of any incident, injury, near-miss, security incident, equipment failure, property or environmental damage, including contamination of any land or water in and around the (project name).
Ensure that all our employees, sub-contractors or other people under our control are qualified and competent to undertake the scheduled work and have been advised of the above mentioned (your company) safety, environment and security requirements and will comply with them.
Renew the above-mentioned

(Your Company) requests you ensure all your employees and all other persons under your control are made aware of all the requirements noted above and in all attachments before entering our premises or commencing any work for us or. Please acknowledge your acceptance of (company) requirements relating to contractors and HSE, by signing below, and returning the completed form to us as soon as possible, along with copies of insurances before commencing or carrying out any further work for us.