Attach SECTION One Colour C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER SECTION C Passport TO BE COMPLETED BY THE ACCREDITED

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Attach SECTION One Colour C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER SECTION C Passport TO BE COMPLETED BY THE ACCREDITED TRAININ Photograph Please G PROVIDER print your name on reverse

1 Attach SECTION One Colour C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER SECTION C Passport TO BE COMPLETED BY THE ACCREDITED TRAININ Photograph Please G PROVIDER print your name on reverse Supervisor, Manager, Senior Manager CSR Application This application form is required for all operatives completing the Supervisor, Manager and Senior Manager Health and Safety training. CSR One Day Health and Safety training applications should be made on form CSR.02 V3.0 SECTION A TO BE COMPLETED BY THE APPLICANT (Please use BLOCK CAPITALS) 1. TYPE OF CARD REQUIRED (Please tick) New Upgrade Skill Area: 2. PERSONAL DETAILS Title: (Mr, Miss, Mrs, Ms) Forename: Surname: Home Address: Telephone Number: National Insurance No: Address: Date of Birth: Post Code: 3. EMPLOYMENT STATUS & DETAILS (Please tick) Employed Self Employed Unemployed Employer Name: Address: Telephone Number: Employer Contact Name: Address: Post Code: 4. NVQ If the Applicant does not hold an NVQ an employer, main contractor or sub-contractor must complete Number 7 below. Applicants should continue at Number 5. NVQ Title: Highest Level NVQ Awarded: Certificate Number: Date Awarded: Do you hold a construction related degree: PLEASE ATTACH A COPY OF NVQ CERTIFICATE If yes, Degree title: 5. CURRENT CARD DETAILS (if known) 6. APPLICANT S SIGNATURE (Applicable only to Renewals and Upgrades. New Applicants please move to Number 6.) Registration Number: Skill Area: Expiry Date: SECTION B I certify that the above details are correct. Signature: Date: TO BE COMPLETED BY THE EMPLOYER (Please use BLOCK CAPITALS) 7. CONFIRMATION OF RELEVANT INDUSTRY EXPERIENCE (OCCUPATIONAL ASSESSMENT/NON-NVQ APPLICANTS) To be completed by the employer. If the Applicant is self-employed or unemployed this section may be completed by a main contractor or sub-contractor. THE APPLICANT MUST NOT SIGN. I certify that the Applicant named above has achieved a satisfactory standard of workmanship and has been engaged in the selected skill area within the last five years. Company Name: Address: Telephone Number: Signature: Position: Address: Post Code: Print Name: Date: FORM CSR.03 V4.0 28/11/2016

2 SECTION C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER 8. CONTACT DETAILS Accredited Training Provider: Contact Name: 9. CHECKLIST (Documents must be retained by Training Provider for monitoring purposes) Date Health and Safety Training Completed: Date CSkills Health & Safety Touch Screen Test Completed: (Required for Site Supervisor Cards only) NVQ Title and Level: Date NVQ Certificate Awarded: OR Date of Assessment: Assessor: Card Colour Awarded: Site Supervisor (Gold) Manager (Platinum) Senior Manager (Black) Skill Category Awarded SECTION C CHECKLIST Copy of one of the required Health and Safety Certificates for Managers/Senior Managers I enclose a cheque for new card and assessment 190+VAT ( 228). Cheques should be made payable to Construction First Ltd, Or I enclose a cheque for a renewal card only 50+VAT ( 60). Cheques should be made payable to Construction First Ltd, Or I have made payment by BACS. Sort Code: , Account No , Danske Bank Colour Passport Photograph enclosed (Please print name on reverse) 10. RETURN OF APPLICATION FORM The completed application form should be returned to: Construction First Limited 143 Malone Road Belfast BT9 6SX SECTION D 11. DATA PROTECTION ACT The information provided by you in this application form will be held on the CSR database and will be used for the following purpose: - to maintain an accurate and up to date record of workers in the construction industry who have met the requirements of CSR We may share your information with our associated service companies and third parties with whom we have a business relationship unless you inform us otherwise in writing. You have a right to apply for a copy of your information and to have any inaccuracies corrected.

3 Construction Skills Register Pre Assessment Questionnaire Building Site Manager 1. Candidate s Personal Details Title (Mr/Miss/Mrs/Ms):... Forename:... Surname:... Home Address: Post Code:... National Insurance No: / / / / Date of Birth: / / 2. Employer s Contact Details Employers Name:... Address: Post Code:... Telephone Number:... Address:... Employer Contact Name: Employment Details Currently Employed By: NVQ Qualifications Assessors Declaration (To be completed following Occupational Assessment) Card Level.. Assessors Name (please print).... Occupation.. Date...

4 Information for Manager Candidates Overview (i) (ii) Candidates for this qualification are expected to have thorough and relevant experience, knowledge and understanding of the organisation and general management of a construction project. They will have a significant role in site management within their company. Candidates are likely to have personal involvement in the functions of preparing programmes and work methods, obtaining resources, controlling progress, safety, quality and costs. They will be responsible for ensuring these functions are carried out properly and that ultimately the customer s requirements are met and the work is carried out effectively, safely and to the appropriate quality:- Candidates should:- Have operational responsibility for a variety of programmes and resources Implement monitoring and control techniques Identify and implement change or improvements in site performance Develop productive working relationships Lead and participate in meetings (iii) In order to fulfil their managerial responsibilities candidates will be required to demonstrate good human resource management through communication, delegation, team building, motivation, control and training.

5 Questionnaire The purpose of this questionnaire is to prepare you and your interviewer on the areas of management that you feel yourself to be competent and that you will be questioned on. The interview is to establish the level of responsibility, involvement and competence that you have in managing the various units described. In order to indicate the extent to which you have been responsible for, involved in and consider yourself competent in the particular subject, please tick through (a) for very, (b) for moderately, (c) for little and (d) for none Unit 1.0 Plan the execution of work for projects Please tick 1.1 Determine methods of work (a) (b) (c) (d) 1.2 Determine work programmes (a) (b) (c) (d) Unit 2.0 Implement works to meet project requirements 2.1 Co-ordinate site preparation (a) (b) (c) (d) 2.2 Establish and implement project organisation and communication systems (a) (b) (c) (d) 2.3 Co-ordinate work control arrangements (a) (b) (c) (d) Unit 3.0 Contribute to obtaining project resources 3.1 Contribute to the provision of materials (a) (b) (c) (d) 3.2 Contribute to the provision of plant and equipment (a) (b) (c) (d) 3.3 Contribute to forming a construction team (a) (b) (c) (d) Unit 4.0 Monitor and control the project 4.1 Monitor and control project process (a) (b) (c) (d) 4.2 Monitor and control project quality standards (a) (b) (c) (d) 4.3 Establish and maintain dimensional control (a) (b) (c) (d) 4.4 Monitor and contribute to the control of project costs (a) (b) (c) (d) Unit 5.0 Develop productive working relationships 5.1 Develop the trust and support of your colleagues and team members (a) (b) (c) (d) 5.2 Develop the trust and support of your manager (a) (b) (c) (d) 5.3 Minimise interpersonal conflict (a) (b) (c) (d) Unit 6.0 Establish and maintain relationships with customers and the community 6.1 Establish and maintain relationships with customers (a) (b) (c) (d) 6.2 Establish and maintain relationships with the community (a) (b) (c) (d) Unit 7.0 Maintain health, safety, welfare and risk control systems 7.1 Maintain systems for managing project health, safety and welfare (a) (b) (c) (d) 7.2 Identify hazards in the workplace (a) (b) (c) (d) 7.3 Assess and control risks in the workplace (a) (b) (c) (d)

6 Unit 8.0 Facilitate meetings 8.1 Lead meetings (a) (b) (c) (d) 8.2 Make contributions to meetings (a) (b) (c) (d) Employer Confirmation As employer I confirm that the above information given by him/her on this questionnaire accurately reflects his/her level of responsibility, involvement and competence. Signature of Employer Date... Position held within Company... Note; Please bring with you to the interview examples of the following: a) Method statements for differing work elements b) Short term programmes (including sub-contractors) c) Contractors site layout(s) d) Material and plant resource schedules and records e) Employers restrictions, constraints f) Site management chart g) Liaison with sub-contractors and suppliers h) Techniques for monitoring progress, quality and cost performance i) Health, safety and welfare systems and assessments j) Minutes of meetings

Attach SECTION One Colour C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER SECTION C Passport TO BE COMPLETED BY THE ACCREDITED

Attach SECTION One Colour C TO BE COMPLETED BY THE ACCREDITED TRAINING PROVIDER SECTION C Passport TO BE COMPLETED BY THE ACCREDITED TRAININ Photograph Please G PROVIDER print your name on reverse Supervisor,