H&S Form

COMPANY DETAILS
Company Name*
Company Address*
Location of Project

Street Address Address Line 2 City ZIP / Postal Code
Site Contact Details*
Contact details of who the engineers will report to.
Full Name Last
Phone*
Email*

DELIVERY, ACCESS & PLANT
1. Restrictions - Please advise if there are any access restrictions on site, or specific days/times we are unable to deliver. (i.e. Early close on Friday)*
2. Are there any site access requirements for the installation team we need to be aware off beforehand?(i.e. key collection, site inductions…etc.)*
3. Offload - The client will ensure access for the delivery vehicle for the off-loading and moving of materials to the build area. Materials to be kept inside where possible.*
- Accept
- I do not Accept
4. PLANT - Scissor lift hire*
We require the continuous use of a scissor lift. (Engineer MEWP licences provided)
- Client to supply
- Dexion Anglia Ltd to supply
4. PLANT - Fork Truck hire*
We require the continuous use of a Fork Truck for the duration of the build.
- Client to supply
- Dexion Anglia Ltd to supply

DELAYS, DEVIATION OR CANCELLATION
1. Delays: Should there be any delays to works which are through no fault of our own, I.E, racks not being clear, or product blocking our progress, additional cost will be applied at the appropriate rates.*
- Yes, I agree
- I do not agree
2. Deviation: The works to be carried out are outlined in the quotations we provided and agreed by yourselves via an official purchase order. Should any further works arise that were not discussed at the point of quotation or should you wish any further works to be carried out, these must be agreed by ourselves and the appropriate costs applied prior to the engineers carrying out these works.*
- Yes, I agree
- I do not agree
3. Cancellation: If you should cancel or want to reschedule the works within 72 hours of the agreed start date, we reserve the right to recoup all installation charges. This will be in addition to any costs quoted to return to site to carry out the installation.*
- Yes, I agree
- I do not agree

COVID-19
1. We are operating within the current COVID-19 restrictions and adherence. Our engineers will keep 2M distance where possible, and will use face masks and appropriate PPE in line with government guidelines.*
Please advise on any Special PPE requirements we should be aware of before attending site?

RAMS & INSURANCES
You would have received our Risk Assessments, Method Statements, company insurances.
1. Have you received, reviewed & agreed our RAMS along with our company insurances?*
- Yes
- No
2. Do you require any further documentation from us?

ADDIDTIONAL INFO & ACCEPTANCE
Additional Details
Anything else will need to know?
Acceptance*
I have read the above and agree to the Dexion Anglia T&C's
I agree to the above information

COMPANY DETAILS