DATE RECEIVED. Do you hold a driving licence? YES / NO. Do you have transport? YES / NO. Reference Enc: YES / Do you have: Are you willing to travel?

Transcription

1 CONTRACT LABOUR HIRE LTD TRADE DATE RECEIVED FORTUNA No: F Surname: Mr/Mrs/Miss/Ms Christian Names: Marital Status: National Insurance No: Are you registered disabled? YES / NO EMPLOYEE No: Address: Nationality: Date of Birth: Pay Type (Please Tick) PAYE UTR NUMBER Minimum Hourly Rate Required Bank/Building Society Details Bank Name: Do you hold a driving licence? YES / NO Do you hold a CSCS Card? YES / NO (Construction Skills Certification Scheme) If yes please enclose a copy Post Code: Branch: Account Name: Do you have transport? YES / NO Categories on CSCS card Telephone No: Mobile No: Account No: Sort Code: - - Roll No: Is your licence subject to convictions? YES / NO If yes please give details: Qualifications: Trade: PLEASE STATE LAST TWO EMPLOYERS CV Enclosed: YES / NO Academic: Company: Address: Tel No: Contact: Dates from to Company: Tel No: Contact: Dates from to Job Title: Duties: Reason for Leaving: Job Title: Duties: Reason for Leaving: Reference Enc: YES / Do you have: Hard Hat Safety Boots Own Tools NO YES / NO YES / NO YES / NO Are you willing to travel? If yes how far: How did you hear about Contract Labour Hire (CLH)? Contractor Family/Friend Internet Job Centre Miles If, before the first Assignment, during the course of an Assignment or within the Relevant Period the Client wishes to employ the Temporary Worker direct or through another employment business, the Temporary Worker acknowledges that the Employment Business will be entitled either to charge the Client a fee or to agree an extension of the hiring period with the Client at the end of which the Temporary Worker may be engaged directly by the Client or through another employment business without further charge to the Client. In addition the Employment Business will be entitled to charge a fee to the Client if the Client introduces the Temporary Worker to a third party who subsequently engages the Temporary Worker within the Relevant Period. DRUGS AND ALCOHOL You (Agency Worker or your Substitute) need to be aware that by accepting an assignment from Contract Labour Hire LTD you may be subject to either random or mandatory Drugs and Alcohol testing from by the hirer, failure to either pass or take the test will result in being denied access to site. Agency Workers involved in accidents and incidents may be subject to For cause testing. Any person who is subject to For cause testing will not be permitted to resume their duties until a negative result is obtained. I CAN CONFIRM THAT I HAVE READ AND UNDERSTOOD THE ABOVE STATEMENT. Newspaper CANDIDATE NAME: SIGNATURE I CONFIRM THAT I AM IN GOOD HEALTH AND HAVE NO CRIMINAL RECORD Signed... Date...

2 All candidates are required by UK legislation and the Employment Agencies Act to provide evidence of their eligibility to work in the UK. Guidance notes on the opposite page must be read before completing this section. Please confirm what documentation you have provided 1) Document 1 to 6 from List A opposite: Yes No If yes, tick which document you have provided Please confirm expiry date of document: 2) If you cannot comply with the request above, you must be able to meet both of the following requests - Document giving your permanent National Insurance Number and your name issued by a government agency or previous employer Please state: Document 7 to 11 from List A opposite, please tick which one

3 Depending on your documentation you will ne eligible to commence temporary work for Contract Labour Hire on an on-going basis, or limited to 12 months after which time your documentation will need to be reviewed. Please ensure you complete the correct section. We need to check your documentation by law. If we are not interviewing you in person, if you are posting originals, please send by registered post as we cannot be held responsible for any loss or damage. We will always return original documentation by registered post immediately. Both we and the hirers are liable for fines of 10,000 per illegal worker so we can take our responsibilities very seriously in this regard. For on-going provision to work, this can be any of the following documents or combination of documents known as List A. 1) A passport showing that you are a British citizen or a citizen of the UK and colonies having the right of adobe in the UK 2) A passport or national identity card showing that you are a national of the European Economic Area (EEA) or Switzerland 3) A residence permit, registration certificate or document certifying or indicating permanent residence issued by the Home Office or UK Border Agency (UKBA) provided that you are a national of the EEA or Switzerland 4) A permanent residence card issued by the Home Office or UKBA provided you are a family member or person from an EEA country or Switzerland 5) A Biometric immigration Document issued by the UKBA to the holder which indicates that you are allowed to stay indefinitely in the UK or have no time limit on your stay in the UK 6) A passport or other travel document endorsed to show that you are exempt from immigration control, are allowed to stay indefinitely in the UK, have the right of abode in the UK, or have no time limit in your stay in the UK If you cannot provide any of the above, then you must provide one of the following combined with an official document giving your permanent National Insurance Number and your name issued by a government agency or previous employer 7) A FULL birth certificate issued in the UK, channel Islands, the Isle of Man or Ireland which include the name(s) of at least one of your parents. [A SHORT birth certificate is not acceptable] 8) An Immigration Status Document issued by the Home Office or the UKBA with an endorsement indicating that you are allowed to stay indefinitely in the UK or have no time limit to stay in the UK 9) A Full adoption certificate issued in the UK, Channel Islands, The Isle of Man or Ireland which indicates the name(s) of at least one of your adoptive parents 10) A certificate of registration or naturalisation stating you are a British citizen 11) A letter issued by the Home Office or the UKBA which indicates you are allowed to stay indefinitely in the UK European Economic Area (EEA) countries are Austria, Belgium, Bulgaria*, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania*, Slovakia, Slovenia, Spain, Sweden, United Kingdom Workers from countries marked * are known as accession State Workers and these workers from these countries are known as A8 workers. If you are from one of these countries we must see evidence of your registration with, or exemption from the Workers Registration Scheme (WRS) in line with guidelines provided by the UKBA. Workers from countries marked * are known as A2 workers which means you are only able to work in the UK if you can provide a valid Accession Worker document. Upon receipt of original documents and in line with our duties under legislation we may contact the UKBA to verify the authenticity of the documents provided.

4 CONTRACT WITH THE TEMPORARY WORKERS (TERMS OF ENGAGEMENT/CONTRACT FOR SERVICES) 1. DEFINITIONS 1.1. In these Terms of Engagement the following definitions apply: Assignment Client Employment Business means the period during which the Temporary Worker is supplied to render services to the Client; means the person, firm or corporate body requiring the services of the Temporary Worker together with any subsidiary or associated company as defined by the Companies Act 1985; Contract Labour Hire Ltd of 16 The Courtyard, Gorsey Lane, Coleshill, Birmingham, B46 1JA Temporary Worker Relevant Period means the longer period of either 14 weeks from the [1] first day on which the Temporary Worker worked for the Client, or 8 weeks from the day after the Temporary Worker was last supplied by the Employment Business to the Client Unless the context otherwise requires, references to the singular include the plural The headings contained in these Terms are for convenience only and do not affect their interpretation. 2. THE CONTRACT 2.1. These Terms constitute a contract for services between the Employment Business and the Temporary Worker and they govern all Assignments undertaken by the Temporary Worker. However, no contract shall exist between the Employment Business and the Temporary Worker between Assignments For the avoidance of doubt, these Terms shall not give rise to a contract of employment between the Employment Business and the Temporary Worker. The Temporary Worker is engaged as a self-employed worker, although the Employment Business is required to make statutory deductions from the Temporary Worker s remuneration in accordance with clause No variation or alteration to these Terms shall be valid unless the details of such variation are agreed between the Employment Business and the Temporary Worker and set out in writing and a copy of the varied terms is given to the Temporary Worker stating the date on or after which such varied terms shall apply. 3. ASSIGNMENTS 3.1 The Employment Business will endeavour to obtain suitable Assignments for the Temporary Worker to work as a. The Temporary Worker shall not be obliged to accept an Assignment offered by the Employment Business. 3.2 The Temporary Worker acknowledges that the nature of temporary work means that there may be periods when no suitable work is available and agrees: that the suitability of the work to be offered shall be determined solely by the Employment Business; that the Employment Business shall incur no liability to the Temporary Worker should it fail to offer opportunities to work in the above category or in any other category; and that no contract shall exist between the Temporary Worker and the Employment Business during periods when the Temporary Worker is not working on an Assignment. 3.3 At the same time as an Assignment is offered to the Temporary Worker the Employment Business shall inform the Temporary Worker of the identity of the Client, and if applicable the nature of their business; the date the work is to commence and the duration or likely duration of the work; the type of work, location and hours during which the Temporary Worker would be required to work; the rate of remuneration that will be paid and any expenses payable by or to the Temporary Worker; and any risks to health and safety known to the Client in relation to the Assignment and the steps the Client has taken to prevent or control such risks. In addition the Employment Business shall inform the Temporary Worker what experience, training, qualifications and any authorisation required by law or a professional body the Client considers necessary or which are required by law to work in the Assignment. 1 P age

5 3.4 Where such information is not given in paper form or by electronic means it shall be confirmed by such means by the end of the third business day ( excluding Saturday, Sunday and any public or bank Holiday) following save where: the Temporary Worker is being offered an Assignment in the same position as one in which the Temporary Worker had previously been supplied within the previous five business days and such information has already been given to the Temporary Worker: or Where subjects to clause 3.5, the Assignment is intended to last for 5 consecutive working days or less and such information has previously been given to the Temporary Worker before and remains unchanged. 3.5 Where an assignment is for five consecutive working days or less and the provisions of clause are met, the Employment Business need only provide the Temporary Worker with written confirmation of the identity of the Hirer and the likely duration of the work. If the Assignment extends beyond the intended five consecutive working day period the Employment Business shall provide such information set out in clause 3.3 to the Temporary Worker in paper or electronic form within eight days of the start of the Assignment. 3.6 For the purpose of calculating the average number of weekly hours worked by the Temporary Worker on an Assignment, the start date for the relevant averaging period under the Working Time Regulations shall be the date on which the Temporary Worker commences the first Assignment. 3.7 If, before the first Assignment, during the course of an Assignment or within the Relevant Period the Client wishes to employ the Temporary Worker direct or through another employment business, the Temporary Worker acknowledges that the Employment Business will be entitled either to charge the Client a fee or to agree an extension of the hiring period with the Client at the end of which the Temporary Worker may be engaged directly by the Client or through another employment business without further charge to the Client. In addition the Employment Business will be entitled to charge a fee to the Client if the Client introduces the Temporary Worker to a third party who subsequently engages the Temporary Worker within the Relevant Period. 4 REMUNERATION 4.1 The Employment Business shall pay to the Temporary Worker remuneration calculated at a minimum hourly rate of 5.30 being the minimum rate of remuneration that the Employment Business reasonably expects to achieve, for all hours worked. The actual rate will be notified on a per Assignment basis, for each hour worked during an Assignment (to the nearest quarter hour) to be paid weekly in arrears, subject to deductions in respect of PAYE pursuant to Sections of the Income Tax (Earnings and Pensions) Act 2003 and Class 1 National Insurance Contributions and any other deductions which the Employment Business may be required by law to make. 4.2 Subject to any statutory entitlement under the relevant legislation, the Temporary Worker is not entitled to receive payment from the Employment Business or Clients for time not spent on Assignment, whether in respect of holidays, illness or absence for any other reason unless otherwise agreed. 5 STATUTORY LEAVE 5.1 For the purposes of calculating entitlement to paid annual leave pursuant to the Working Time Regulations 1998 under this clause, the leave year commences. 5.2 The annual leave granted under these terms will always be the statutory minimum as it is from time to time. Under the Working Time Regulations 1998 (as amended), the Temporary Worker is entitled to annual leave as follows: For work carried out between April 2016 to 3April 2017: 5.6 weeks. For work carried out from 1 April 2016 onwards: 28 days including statutory. If the statutory minimum leave is subsequently decreased or increased then entitlement to leave under this clause will be decreased or increased so as to be set at the statutory minimum as it applies to any period in which work is carried out. 5.3 All entitlement to leave must be taken during the course of the leave year in which it accrues and none may be carried forward to the next year. 5.4 Where a Temporary Worker wishes to take paid leave during the course of an assignment s/he should notify the Employment Business of the dates of his/her intended absence giving notice of at least twice the length of the period of leave that s/he wishes to take. In certain circumstances the Employment Business may give counter-notice to the Temporary Worker to postpone or reduce the amount of leave that the Temporary Worker wishes to take and in such circumstances the Employment Business will inform the Temporary Worker 2 P age

6 in writing giving at least the same length of notice as the period of leave that it wishes to postpone or reduce it by. 5.5 Entitlement to payment for leave accrues in proportion to the amount of time worked continuously by the Temporary Worker on Assignment during the leave year. The amount of payment which the Temporary Worker will receive in respect of periods of annual leave taken during the course of an Assignment will be calculated in accordance with and paid in proportion to the number of hours which the Temporary Worker has worked on Assignment. 5.6 In the course of any Assignment during the first leave year the Temporary Worker is entitled to request leave at the rate of one-twelfth of the Temporary Worker s total holiday entitlement in each month of the leave year. 5.7 Where a Bank Holiday or other Public Holiday falls during an Assignment and the Temporary Worker does not work on that day, then subject to the worker having accrued entitlement to payment for leave in accordance with clause 5.5, that day shall count as part of the Temporary Worker s paid annual leave entitlement. Alternatively 5.7 Where a Bank Holiday or other Public Holiday falls during an Assignment and the Temporary Worker does not work on that day, then subject to the worker having accrued entitlement to payment for leave in accordance with clause 5.5 the Temporary Worker may, upon giving one week s notice, take a Bank Holiday or other Public Holiday as part of his/her paid annual leave entitlement. 5.8 Where this contract is terminated by either party and a P45 is requested, the Temporary Worker shall be entitled to a payment in lieu of any untaken leave where the amount of leave taken is less than the amount accrued in accordance with clause None of the provisions of this clause regarding the statutory entitlement to paid leave shall Affect the Temporary Worker s status as a self-employed worker. 6 SICKNESS ABSENCE 6.1 The Temporary Worker may be eligible for Statutory Sick Pay provided that s/he meets the relevant statutory criteria. 6.2 For the purposes of the Statutory Sick Pay scheme there is one qualifying day per week during the course of an assignment and that qualifying day shall be the Wednesday in every week. 7 TIME SHEETS 7.1 At the end of each week of an Assignment (or at the end of the Assignment where it is for a period of one week or less or is completed before the end of a week) the Temporary Worker shall deliver to the Employment Business a time sheet duly completed to indicate the number of hours worked during the preceding week (or such lesser period) and signed by an authorised representative of the Client. 7.2 Subject to clause 7.3 The Employment Business shall pay the Temporary Worker for all hours worked regardless of whether the Employment Business has received payment from the Client for those hours. 7.3 Where the Temporary Worker fails to submit a properly authenticated time sheet the Employment Business shall, in a timely fashion, conduct further investigations into the hours claimed by the Temporary Worker and the reasons that the Client has refused to sign a timesheet in respect of those hours. This may delay any payment due to the Temporary Worker. The Employment Business shall make no payment to the Temporary Worker for hours not worked. 7.4 For the avoidance of doubt and for the purposes of the Working Time Regulations, the Temporary Worker s working time shall only consist of those periods during which s/he is carrying out activities or duties for the Client as part of the Assignment. Time spent travelling to the Client s premises; lunch breaks and other rest breaks shall not count as part of the Temporary Worker s working time for these purposes. 8 CONDUCT OF ASSIGNMENTS 8.1 The Temporary Worker is not obliged to accept any Assignment offered by the Employment Business but if s/he does so, during every Assignment and afterwards where appropriate, s/he will: a) Co-operate with the Client s reasonable instructions and accept the direction, supervision and control of any responsible person in the Client s organisation; b) Observe any relevant rules and regulations of the Client s establishment (including normal hours of work) to which attention has been drawn or which the Temporary Worker might reasonably be expected to ascertain; 3 P age

7 c) Take all reasonable steps to safeguard his or her own health and safety and that of any other person who may be present or be affected by his or her actions on the Assignment and comply with the Health and Safety policies and procedures of the Client; d) Not engage in any conduct detrimental to the interests of the Client; e) Not at any time divulge to any person, nor use for his or her own or any other person s benefit, any confidential information relating to the Client s or the Employment Business employees, business affairs, transactions or finances. 8.2 If the Temporary Worker is unable for any reason to attend work during the course of an Assignment s/he should inform the Client and/or the Employment Business within one hour of the commencement of the Assignment or shift. 8.3 If, either before or during the course of an Assignment, the Temporary Worker becomes aware of any reason why he may not be suitable for an Assignment, he shall notify the Employment Business without delay. 9 TERMINATION 9.1 The Employment Business or the Client may terminate the Temporary Worker s Assignment at any time without prior notice or liability. 9.2 The Temporary Worker may terminate an Assignment at any time without prior notice or liability. 9.3 If the Temporary Worker does not inform the Client or the Employment Business [in accordance with clause 8.2] should they be unable to attend work during the course of an assignment this will be treated as termination of the assignment by the Temporary Worker in accordance with clause 9.2 unless the Temporary Worker can show that exceptional circumstances prevented him or her from complying with clause If the Temporary Worker is absent during the course of an assignment and the contract has not been otherwise terminated under clauses 9.1, 9.2 or 9.3 above the employment business will be entitled to terminate the contract in accordance with clause 9.1 if the work to which the absent worker was assigned is no longer available for the Temporary Worker. 9.5 If the Temporary Worker does not report to the Employment Business to notify his/her availability for work for a period of three weeks, the Employment Business will forward his/her P45 to his/her last known address. 10 LAW 10 These Terms are governed by the law of England and are subject to the exclusive jurisdiction of the Courts of England Signed by the Temporary Worker* Date 4 P age

8 Drugs and Alcohol Awareness. Policy & Procedure For temporary workers. D&A/04/2013

9 Distribution: All temporary staff employed / supplied by Contract Labour Hire Ltd to Clients operating in a safety critical environment. Who this policy applies to: All Contract Labour Hire Ltd candidates. Contract Labour Hire Ltd works closely with a number of Main and sub contractors throughout the Construction industry. We are committed to ensuring the health and safety of candidates we place on site, and those that they work with, through monitoring those who are unfit for work through being under the influence of Alcohol or recreational drugs, or those who consume or are in possession of alcohol or drugs that may impair safety on site. Part Contract Labour Hire Ltd s policy is a zero tolerance attitude towards drug and alcohol abuse / misuse. This policy will ensure that where candidates are screened for pre employment drugs and alcohol tests, they are fully aware of the policies in place through Contract Labour Hire Ltd. All employees will be sent copies of the procedure for their records and all new starters will be issued with a copy prior to commencement of contracts. This will be included in their starter packs to ensure disclosure prior to reaching site. Alcohol: We expect staff to exercise caution prior to working on safety critical sites where testing may be carried out. Whilst we appreciate that alcohol is a positive part of life for many people, we advise that the prior to the following situations, it would be best to avoid drinking at all: Before or during Driving and vehicle. Before using machinery, electrical equipment. Before working, or whilst in the workplace, when appropriate functioning would be adversely affected by alcohol. In situations where lack of appropriate function may endanger yourself or other colleagues in the workplace. Alcohol should not be taken to, or purchased, whilst working on site under any circumstances. Whilst attending Company functions (training, client entertaining, Christmas parties etc), candidates should ensure that they do not exceed the company s operating unit s consumption level of alcohol prior to returning to work. We would suggest that only non-alcoholic beverages are consumed to avoid confusion and to prevent potential removal from site.. D&A/04/2013

10 Drugs: Staff of Contract Labour Hire Ltd are expressly prohibited from the participation and misuse of illegal / recreational drugs or substances. Contract Labour Hire Ltd does not approve of the usage of non-prescribed drugs on site. Medication prescribed by a qualified medical professional is acceptable in certain cases. In these circumstances you must notify your consultant prior to accepting any positions The use, possession, consumption or selling of illegal drugs as well as the misuse of prescribed drugs on site, or prior to reporting to site, will result in removal from your location and an immediate termination of your contract with Contract Labour Hire Ltd. This may affect the opportunity for future work dependant upon the prevailing circumstances. All workers through Contract Labour Hire Ltd must comply with the following guidelines: Do not attend site whilst under the influence of Alcohol or Drugs. Do not take alcohol onto site, or purchase alcohol during shift, for consumption whilst on site. Do not take illegal Drugs / substances to site for consumption or sale. Do not operate or drive any machinery / vehicle whilst you are, or believe that you may be, affected by prescribed / over the counter / recreational drugs or alcohol. Notify your consultant / shift supervisor if you are taking any prescribed or over the counter medication which you believe may affect your work. Do not misuse legal substances that may be used in the workplace, such as solvents and glue. Please be aware that failure to take on board the guidelines outlined above may result in termination of works with Contract Labour Hire Ltd on current and future contracts. Pre Employment Testing how this works: An appointed officer working at the request of Select Plant Hire, as part of the Laing O Rourke Group, will arrange for new employees to be tested at a location previously agreed with Contract Labour Hire Ltd. You will attend a pre employment drugs and alcohol test and the results will be forwarded to BRR. Should the results show a negative result; your contract of employment will be approved. Should the test result return positive, further testing will be carried out to assess whether you are taking illegal / banned substances. No contract will be awarded whilst this is pending. The employee will need to give permission for the test to be completed, and will be required to sign a screening consent and results form. Failure to comply will be deemed as a positive result and will conclude in refusal of a contract of employment. D&A/04/2013

11 Random Testing how this works: An appointed officer working at the request of Select Plant Hire, as part of the Laing O Rourke Group will be present on site with a list of workers from a dedicated representative. These workers will have been randomly selected from a cross section of employees at Select Plant Hire, as part of the Laing O Rourke Group. The employee will need to give permission for the test to be completed, and will be required to sign a screening consent and results form. Failure to comply will be deemed as a positive result and will conclude in immediate removal from site and termination of the workers contract. Responsibilities: Consultant: It is the consultants responsibility to ensure that all workers have received a copy of, and have understood Contract Labour Hire Ltd s policy for Drug and Alcohol misuse and testing. The Consultant will be responsible for reporting any issues to site and requesting medical evidence for all prescribed medications. They will also be responsible for highlighting any issues with the temp and advising of removal from site where an employee tests positive for any drug / alcohol / illegal substances. Client / Shift Supervisor: It is the responsibility of the client and their appointed shift supervisor to notify Contract Labour Hire Ltd of any concerns that they may have, whilst a temporary worker is on site. They are to be aware of the policy and procedures in place and should be able to act within the paramenters set out in these documents. Temporary Worker: It is the workers responsibility to be familiar with the procedure surrounding drug and alcohol policies prior to commencing work on site. Should you be required to take prescribed medication, or are using over the counter medication, then you need to ensure that you are informing the correct personal prior to any routine tests being carried out on site. Where possible, it will be your responsibilty to relay evidence of prescribed medication or relay details of over the counter purchases to the relevant consultant at Contract Labour Hire Ltd, and to your manager on site. D&A/04/2013

12 Drugs and Alcohol disclosure. We may require Candidates to undergo drugs and alcohol testing on site. These tests are done randomly by Select Plant Hire, as part of the Laing O Rourke Group, with no suspicion of the employees in question having taken banned substances. The majority of pain killers, including those commonly used by most of us, contain opiates and will therefore show up on a drugs screening if taken regularly. Please confirm that you agree and are happy with the procedures set out in this document with regards to drug and alcohol testing. 1 I confirm that the test was undertaken routinely and without cause. 2 I am happy to undertake routine tests on site, and confirm that the consequences of failing any Drug & Alcohol test have been explained to me prior to the commencement of employment. 3 I can confirm that I have not taken nor am I under the influence of any illegal substances / narcotics / opiates / alcohol. 4 I am not currently / have not recently taken any prescription / over the counter based medication. 5 I understand, and am happy, that I may be required to remain at work whilst awaiting laboratory results for prescribed / over the counter medication. And understand that I may only work in a non safety critical role for a period of up to 2 weeks. If you regularly & routinely take medication which may show up on a test, please notify Contract Labour Hire Ltd of the medication taken and method of obtainment. Where medication has been prescribed we may seek a medical report to confirm this. Where medical evidence is available, it will likely be permitted for employees to continue with their normal duties even if a drugs test has been failed, though there are clients who will NOT permit a worker to remain on site having failed a test regardless of medical exemption / confirmation. Please note that any screening failure that relates to other banned substances including alcohol, cocaine & cannabis must result in immediate suspension from work pending further investigation. D&A/04/2013

13 Please remember the safety of other employees and all those affected by them is paramount. If you are in any doubt as to the fitness of an employee to work, they must be suspended from duties. If you are currently taking any prescription / over the counter medication please indicate which medicines you are using: I confirm that the information I have provided to Contract Labour Hire Ltd is true and accurate. I understand that any false information provided will result in my immediate removal from site and also from further works with Contract Labour Hire Ltd. Signed Date D&A/04/2013

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15 CONTRACT LABOUR HIRE LTD QUESTIONNAIRE A GUIDE TO HEALTH AND SAFETY ON SITE Name Payroll No Trade Date 1 Under The Health and Safety at work act, personal responsibility is set out as three basic duties. Name one. 2 No matter how small, where must all accidents and injuries be recorded? 3 If you are injured at work, whose responsibility is it to report it? 4 There is a minimum of two and often three items of safety wear which must be worn on site. Name them. 5 You must wear suitable gloves when handling what type of materials? 6 If you are required to use electrically operated tools that you see are worn or defective, what must you do? 7 What must you have before operating any item of mobile plant? 8 What does C.O.S.H.H. stand for? 9 What does a C.O.S.H.H. Assessment tell you? 10 Before climbing a ladder, there must be one of two safety measures in place. Name either. 11 On refurbishment contracts, what should you check for before removing insulation or lagging? 12 On Site, what voltage should temporary electricity supply be? 13 In what circumstances do you need to use ear protection? 14 What footwear must be worn on site? 15 If you are afraid or unsure about substances, equipment or systems of work that affect you, what must you do?

16 CONTRACT LABOUR HIRE LIMITED EMERGENCY CONTACT SHEET Employees Name: Date: Next of Kin ( Contact 1) Name: Relationship: Address: Post Code: Home Tel No: Work Tel No: Mobile Tel No: Next of Kin ( Contact 2) Name: Relationship: Address: Post Code: Home Tel No: Work Tel No: Mobile Tel No: IF ANY OF THE ABOVE DETAILS CHANGE PLEASE LET CONTRACT LABOUR HIRE LTD KNOW IMMEDIATELY

17 CONTRACT LABOUR HIRE LTD MEDICAL QUESTIONNAIRE FOR TEMPORARY WORKERS Please complete the questionnaire below in full and to the best of your knowledge. This questionnaire then enables us to decide whether a medical examination is necessary before commencement of work. 1. Have you consulted a doctor or psychiatrist within the last 5 years? Yes No (excluding consultations for common cold, influenza or pregnancy without complications) If yes, please give details: 2. Are you currently receiving treatment dietary, medicines, tablets Yes No or injections - whether prescribed or not for any condition? If yes, please give details: 3. Have you or are you currently suffering from any of the following: Yes No a) Any disease of the heart or circulatory system? Yes No If yes, please give details: b) Strokes or high blood pressure? Yes No c) Diabetes Yes No d) Asthma, bronchitis or any other respiratory Yes No complaints or disorders? e) Rheumatism, arthritis, gout or any form of back complaint Yes No or joint / muscle disorders? f) Any form of mental disorders or required tranquilisers Yes No or anti-depressants? g) Any disease or disorders of the eye? Yes No h) Any hearing disease, disorder or partial deafness? Yes No 4. General a) Do you have problems working at heights? e.g.: Vertigo Yes No b) Are you capable of manual lifting and handling? Yes No 5. Declaration I declare that the above information is correct to the best of my knowledge, and that statements provided are true and complete, and that all material facts have been disclosed. Signed: Address: Print Name: Date:

18 Contract Labour Hire Health and Safety Guide 2012 Point of Work Risk Assessment, when attending client site: Have you been briefed and signed on the method statement and associated documentation for the task? (Risk Assessments, Permits, COSHH etc) Do you have the correct PPE and equipment to do the job? Is plant and equipment in good condition? Have you carried out Pre Start checks on the plant and equipment? Are you physically fit to do the task? Have manual handling activities been assessed and recorded? Do you know the emergency procedures? Do you know who the first aider is? Do you have the right training certificate or licence to use or operate the plant and equipment? Is it safe to continue without any pedestrian plant segregation? Can you work safely at Height? Is your work area safe? Do you have a safe means of access/egress, including from excavations? Are excavations fully enclosed with suitable barriers? Has the exposure to noise or vibration been assessed, recorded, monitored? Weather conditions (is it safe to carry out the task?) Are there adequate Warning Signs? Have you CAT Scanned and recorded it? Did you answer NO to any Questions? Stop!! Inform the problem and seek advice from your Supervisor NOW

19 48 HOUR OPT OUT AGREEMENT DEFINITIONS 1.1. In this Agreement the following definitions apply: Agency Worker means ; Assignment means the period during which the Agency Worker is supplied to provide services to the Client; Client means the person, firm or corporate body using the services of the Agency Worker; Employment Business means Contract Labour Hire LTD (Company REG ) Working Week means an average of 48 hours each week calculated over a 17-week reference period References to the singular include the plural and references to the masculine include the feminine and vice versa The headings contained in this Agreement are for convenience only and do not affect their interpretation. 2. RESTRICTION The Working Time Regulations 1998 (as amended) provide that the Agency Worker shall not work on an Assignment with the Client in excess of the Working Week unless she/he agrees in writing that this limit should not apply. 3. CONSENT The Agency Worker hereby agrees that the Working Week limit shall not apply to the Assignment. 4. WITHDRAWAL OF CONSENT 4.1. The Agency Worker may end this Agreement by giving the Employment Business three months notice in writing For the avoidance of doubt, any notice bringing this Agreement to an end shall not be construed as termination by the Agency Worker of an Assignment with a Client Upon the expiry of the notice period set out in clause 4.1 the Working Week limit shall apply with immediate effect. 5. THE LAW This Agreement is governed by the law of England & Wales and is subject to the exclusive jurisdiction of the Courts of England & Wales. SIGNATURE.. DATE.

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