COMPANY INFORMATION - Kaydee Blinds · 2019-11-08 · 4.0 Certificate of Incorporation 13 5.0 Insurance Documents 14-15 6.0 Bank Details 16 7.0 Tax Details 17 8.0 Health and Safety

COMPANY INFORMATION

1.0 Introduction - Our Company 31.1 Introduction - Our Products 42.0 Key Projects 5-9 A. Riverlights 5 B. Corniche 6 C. Cartwright Gardens 7 D. Old Street Yard 8 E. Bladerunner 93.0 Staff Responsibilities 10-113.1 Company Structure 124.0 Certificate of Incorporation 135.0 Insurance Documents 14-156.0 Bank Details 167.0 Tax Details 178.0 Health and Safety 188.1 IOSH (Roy South) 198.2 IOSH (Steve Butterfield) 208.3 Citation Certificate 218.4 Citation Advisor 22-239.0 Environmental Statement 2410.0 Quality Assured ISO 9001 : 2015 2510.1 Quality Assured ISO 18001 : 2007 2610.2 Quality Assured ISO 14001 : 2015 2711.0 CHAS Certificate 2811.1 Construction Line Certificate 2911.2 Safe Contractor Certificate 3011.3 SMAS Certificate 3112.0 Operatives Training & Qualification List 3213.0 Example RAMS Document 33-3614.0 Accident Reporting Procedure 3714.1 Accident Reporting Flowchart 3914.2 Accident Reporting Form 3915.0 CIS 40

CONTENTS

2

KAYDEE COMPANY INFORMATION

1.0 Introduction

Our CompanyWe are leading suppliers of commercial blinds and curtains, as well as our own more innovative shading solutions. We work with you to provide results that fit the brief and are installed on time and within budget. Each project is customised and run to meet your needs, is project-managed using proven systems and installed either by our own teams or by Kaydee-trained operatives.

Kaydee finds the best adapted solution for projects as diverse as student accommodation and hotels, schools and universities, retail, commercial and leisure. Our range is extensive to make sure we can always propose the optimum solution matching function and style to technical and budget demands.

Kaydee has been supplying light control solutions since 1985.

STANDARDS AND METHODOLOGIES

Kaydee is accredited to ISO9001, ISO14001 andISO 45001 quality standards. Kaydee are subscribers to RIBA NBS.

3


1.1 Introduction

Our ProductsROLLER BLINDS

Our Shada range has three main models to suit every budget and application including manual and automatic operation. Specialist models include tensioned roof-light blinds, blackout blinds and rooflights blinds.

VENETIAN BLINDS

A wide range of sizes, colours and operational methods is available so we can guide your choice towards the perfect solution. The range includes chain, crank and electric operation as well as the more traditional cord and wand control.

VERTICAL BLINDS

Our Spectra range has something for everyone. Wand operation is an option to avoid draping cords and the range now extends to include X-Ray protection blinds for healthcare applications.

CURTAINS

The traditional solution: curtain and tracking solutions that have no real restrictions for size, budget and fabric. We have specialist solutions for healthcare, including light control, sound control and electrical operation.

4


“Site was fully resourced as required to suit programme requirements for blind installation when sufficient notice was given.”

Ismail Sidat

2.0 A Key Projects

RiverlightsProject Name Riverlights

Client St James - Berkeley Group

Value £815,000.00

Contact Ismail Sidat

Product 411 Electric Curtain Tracks

2873 Shada 500 Roller Blinds

793 Shada 500 Electric Roller Blinds

Points of Service Project management over a two-year period

Reference

5


Project Name Corniche

Client St James

Value £450,000.00

Product 131 Silent Gliss 4910 Roller Blinds

852 Silent Gliss 3840W Curtain Tracks

48 Silent Gliss 5100 Electric Curtain Tracks

900 Kaydee Contract Curtains

Points of Service The Project involved very high number of individually template curtain tracks

Reference

Corniche

“Kaydee have just successfully completed the blinds and sheers package on one of our prestige developments in central London. The project includes very high spec apartments and included a lot of curved sheer tracks and a number of electric controlled blinds and sheers.

There have been no issues with the quality of the product or installation. Kaydee achieved a shortened programme, due to our delays, which helped us mitigate these delays and therefore lessened the impact on our customers. I am very pleased that Kaydee were tending my new project when I joined and delighted to say that they have just secured Phase 1, 299 apartments”.

Trevor Hunter Commercial Manager, St James

2.0 B Key Projects

6


Cartwright GardensProject Name Cartwright Gardens

Client Multiplex / UPP

Value £200,000.00

Product 1368 Shada Manual Roller Blinds

41 Shada Electric Roller Blinds

Points of Service Completed project to an abnormally tight time schedule

Reference “I would like to thank Sean and the team for their hard work on the project and for helping us achieve PC despite an extremely difficult programme“.

Senior QS Jacob Roderick

2.0 C Key Projects

7


Project Name Old Street Yard

Client Brookfield Multiplex

Value £189,000.00

Product 1414 Roller blinds

Points of Service Tight Project timescale

Old Street Yard

2.0 D Key Projects

8


Project Name Bladerunner

Client News UK

Value £767,000.00

Product 650 Awnings

Points of Service 450 sites

Survey manufacture and install completed in four months

Bladerunner

2.0 E Key Projects

9


DIRECTORS

Clive and Roy South

MANAGEMENT

Roy South - Managing Director

HUMAN RESOURCES

Emma Newton – Human Resources Manager and PA to Directors

OPERATIONS TEAM

Sean McConnell – Contracts Manager

Kerry Seager – Project Manager

Carl Hayes – Surveyor

David Ford – Surveyor

Debbie Brocklehurst – Operations Co-ordinator

Michael Sturgess - Operations Co-ordinator

Matt Sewell – Internal Site Operative

SALES & ESTIMATING TEAM

Kris Wilcox - Sales and Estimating Manager

Greg Edwards - Technical Co-ordinator

Maria Askar - Area Sales Co-ordinator

Adam Peet- Area Sales Co-ordinator

Cameron Scarle - Assistant Estimating Manager

Savannah Gill - Evaluator & Sales Estimator

Kial Rontree - Sales Estimator

Anita Ward - Group Sales Estimator

3.0 Staff Responsibilities 10


MARKETING

Robert Hall – Group Marketing Manager

PURCHASING

Dlovan Askar – Group Purchasing Manager

FINANCE

Rebecca Wilford - Group Finance Administrator

Alan Thorpe - Group Credit Controller

INTEGRATED MANAGEMENT/HEALTH & SAFETY

Steve Butterfield – Group IMS Manager

WAREHOUSE OPERATIONS

Darren Stanyon – Group Warehouse Manager

OPERATIVES - SUB CONTRACTED

Matt Mazurkievicz

Dan Biddle

Ben Phillips

Andy Askew

Paul Hore

Steve Sloan

Mark Hipkiss

Richard Popps

Andy Blount

Andy Jones

Sharon Phillips

Matt Fowler

Stuart Jeffrey

3.0 Staff Responsibilities 11


Kris Wilcox SALES &

ESTIMATING MANAGER

Steve ButterfieldIMS MANAGER

Robert Hall MARKETING MANAGER

KAYDEE LIGHT CONTROL SOLUTIONSSAYFA SYSTEMS RHINODECK

PROPCO CONSTRUCT GROUP

Emma Newton

HR MANAGER

Sean Mcconnell OPERATIONS

MANAGER

3.1 Company Structure

Sales Area 1 North

Sales Area 2 Midlands

Sales Area 3 South

Installations Team 1

Installations Team 2

Greg Edwards TECHNICAL

CO-ORDINATOR

Sean Mcconnell OPERATIONS

MANAGER

Kerry Seager PROJECT

MANAGER

Maria Askar AREA SALES

CO-ORDINATOR

Adam Peet AREA SALES

CO-ORDINATOR

AREA SALES

CO-ORDINATOR

Carl Hayes SURVEYOR

David Ford SURVEYOR

Michael Ciura SALES

EVALUATOR& ESTIMATOR

Kial Rontree

SALES ESTIMATOR

Anita Ward Debbie Brocklehurst

OPERATIONS CO-ORDINATOR

Michael Sturgess

OPERATIONS CO-ORDINATOR

FITTING TEAM 2FITTING TEAM 1

12

GROUP SALES ESTIMATOR


4.0 Certificate of Incorporation 13

TO WHOM IT MAY CONCERN 27th August 2019 Name of Insured: Propco Construct Group Ltd, Sayfa Systems UK Limited, Rhino Deck Limited, Propco Developments (Derby) Limited, Kaydee Blinds Ltd, Kaydee Light Control Solutions Ltd & Buroshade Ltd. Principal Address: Jubilee House, Unit 3 Gelders Hall Road, Shepshed, Loughborough, LE12 9NH We can confirm that we act as insurance brokers on behalf of the above insured, and based on the information provided to us, we are writing to confirm, as at the date of this letter, brief details of our Clients’ insurance cover for your information as follows:

Employers' Liability

Insurer: Aviva Insurance Limited

Policy Number: 100662845CCI

Cover Basis: Insurers will indemnify the above client in respect of their legal liability to pay compensation and claimants’ costs and expenses in respect of death, bodily injury, illness or disease sustained by employees during the course of their employment in Insured’s business.

Cover Period: 12th September 2019 to 11th September 2020

Indemnity Limit: £10,000,000 any one occurrence, costs inclusive

Public Liability

Insurer: Aviva Insurance Limited

Policy Number: 100662845CCI

Cover Basis: Insurers will indemnify the above client in respect of their legal liability to pay compensation and claimants’ costs and expenses in respect of death, injury, illness or disease and third party property damage arising out of their business.

Cover Period: 12th September 2019 to 11th September 2020

Indemnity Limit: £5,000,000 any one occurrence


6.0 Bank Details 16


7.0 Tax Details 17


8.1 IOSH (Roy South) 19

Citation ApprovedHealth & Safety

Management Systems

To assist in achieving compliance with their Health & Safetyobligations, Citation Ltd has been appointed to act as advisors

by

Propco Construct Group LimitedCitation Ltd has carried out an inspection of the premises and installed a Health &

Safety Management System which will enable the organisation to promote andmanage a safe working environment.

Signed on behalf of Citation Ltd

Director of Health & Safety: Lee Mills

Valid from: 10/01/2019

Valid To: 09/01/2022

Certificate number: ATLCC-0000019903

Kings Court . Water Lane . Wilmslow . Cheshire . SK9 5AR . T 0161 667 4000 . F 01625 415 679

E [email protected] . citation.co.uk . Registered in England No. 3097504


We’re passionate about what we do...By being experts at what we do, we can help our clients take their business to the next level. This is only possible due to the high standards of our team providing our range of services. Employment Law or Health & Safety, our consultants are fully qualified and ready to support you.

0845 844 1111

[email protected]

Citation Ltd Kings Court Water Lane Wilmslow Cheshire SK9 5AR

FS 57728 ISO 9001: 2008

8.4 Citation Advisor 22

Citation Ltd, Kings Court, Water Lane, Wilmslow, Cheshire, SK9 5AR

0345 844 1111

[email protected]

Your Health & SafetyConsultant...

Elaine Bagshaw

Elaine is a highly knowledgeable and qualified Health & Safety professional, with more than 20 years’ experience in the industry. Over the years, she’s worked with a diverse range of businesses – of various sizes and sectors – to help them achieve high standards of Health & Safety.

She holds a Post-Graduate Diploma in Health and Safety Risk Management, a Diploma in Safety, Health and Environmental Management, and a OHSAS 18001 Lead Auditor qualification.

Elaine is incredibly adept when it comes to offering bespoke, practical solutions, and has been delivering expert Health & Safety advice to people across all businesses levels.

Areas of expertise:

– Developing and implementing policies &procedures

– Training and coaching

– Risk assessments

– Site inspections

– Accident investigation and reporting

– COSHH

– DSE

– Fire safety management

– Health surveillance

– Manual handling

– PPE

– Working at height

– Workplace transport.

PG Dip, CMIOSH

Chartered Safety and Health PractitionerCMIOSH Member no: 21545

This document certifies that the quality management systems of

PROPCO CONSTRUCT GROUP LTD INCORPORATINGSAYFA SYSTEMS UK LTD, KAYDEE LIGHT CONTROL SOLUTIONS LTD & RHINO DECK LTD

Jubilee House, 3 Gelders Hall Road, Shepshed, Leicestershire LE12 9NH

have been assessed and approved by QMS International Ltd to thefollowing quality management systems, standards and guidelines:-

ISO 9001 : 2015

The approved quality management systems apply to the following:-THE DESIGN, ASSEMBLY, SUPPLY, INSTALLATION AND MAINTENANCE OF FALL ARREST, SAFETY

PLATFORM SYSTEMS AND EQUIPMENT; THE ASSEMBLY, SUPPLY AND INSTALLATION OF COMMERCIALBLINDS, CURTAINS AND TRACKS; AND THE SUPPLY OF MODULAR, FREE-STANDING AND LOAD-BEARING

PLATFORM DECKING

Original Approval: 05 September 2019

Current Certificate: 05 September 2019

Certificate Expiry: 04 September 2020

Certificate Number: 320822019

On behalf of QMS International Ltd

This Certificate remains valid whilethe holder maintains theirmanagement system in

accordance with the publishedstandard. To check the validity and

status of this certificate pleaseemail [email protected]

This Certificate is the property ofQMS International Ltd and must be

returned in the event ofcancellation

ISO 9001 REGISTERED

This document certifies that the environmental management systems of

PROPCO CONSTRUCT GROUP LTD INCORPORATING SAYFA SYSTEMS UK LTD, KAYDEELIGHT CONTROL SOLUTIONS LTD & RHINO DECK LTD


have been assessed and approved by QMS International Ltd to thefollowing environmental management systems, standards and guidelines:-

ISO 14001 : 2015

The approved environmental management systems apply to the following:-THE DESIGN, ASSEMBLY, SUPPLY, INSTALLATION AND MAINTENANCE OF FALL ARREST, SAFETY


PLATFORM DECKING











ISO 14001 REGISTERED

This document certifies that the occupational health and safety management systems of

PROPCO CONSTRUCT GROUP LTD INCORPORATING SAYFA SYSTEMS UK LTD, KAYDEELIGHT CONTROL SOLUTIONS LTD & RHINO DECK LTD


have been assessed and approved by QMS International Ltd to thefollowing occupational health and safety management systems, standards and guidelines:-

ISO 45001: 2018

The approved occupational health and safety management systems apply to the following:-THE DESIGN, ASSEMBLY, SUPPLY, INSTALLATION AND MAINTENANCE OF FALL ARREST, SAFETY


PLATFORM DECKING











ISO 45001 REGISTERED

Kaydee Light Control Solutions Ltd T/A

Kaydee Blindshas demonstrated compliance with the CHAS

standards in line with SSIP Core Criteria and UK H&S Legislation and has been awarded

accreditation to the requirements of the CDM Regulations 2015

22JANUARY

2020

Contractor - Construction

The information on this certificate is correct at the time of issue. To confirm the validity of a contractor, please visit https://portal.chas.co.uk


11.1 Construction Line Certificate

160526

21/10/2019

Kaydee Light Control Solutions Ltd

29

Certificate of Accreditation

This is to certify thatKaydee Light Control Solutions Ltd

has achieved SafeContractor accreditation

Date: 11th February 2019

This certificate is valid until: 1st March 2020

Certificate number: OQ6526

Signed:

Alyn FranklinAlcumus CEO

Alcumus SafeContractor, Axys House, Parc Nantgarw, Cardiff, CF15 7QX

T: 029 2026 6749 E: [email protected] W: www.alcumusgroup.com | www.safecontractor.comThis certificate is the property of Alcumus SafeContractor and must be returned on request

Kaydee Light Control Solutions Ltd t/a Kaydee Blinds

Contractor

22/01/2020 78973


12.0 Operatives Training & Qualification ListCS

CSPA

SMA

SSST

SIP

AFFi

rst

Aid

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Confi

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32


13.0 Example RAMS Document

RAM Expert Tooling & Automation - Lyons Park

METHOD STATEMENT

(Risk Assessment Attached)

a) MA1792

a) Pack blinds in warehouse for transit

c) Travel to site following surveyor’s directions as necessary

b) Itemise from survey and load in sequence

4.0 Plant and equipment

i) Test blind for correct operation

h) Fit brackets first, then fit hardware

c) Access equipment

b) Hand tools

a) Battery powered hand drills

d) Park in designated area and report to site office/client representative

l) Job sheet to be signed off by client/contractor

k) Clean up and dispose of waste packaging

j) Remove access equipment

g) Position access equipment, working height 2.5M. (See Attached Risk Assessment).

f) Distribute items as per surveyor’s plan

e) Unload near to site in a safe location and re-park as necessary

a) To supply and install 70 vertical blinds

1.0 Method statement intent and introduction

3.0 Description of works

b) Expert tolling & Automation Limited

2.1 PC No. Client:

a) Lyons Park, New production facility for Expert

Tooling & Automation, Lyons Park, Coventry, CV5

9DQ

2.0 Location of works

Page 1 of 2

33


RAM Expert Tooling & Automation - Lyons Park

Method statement prepared by: Michael Sturgess

Approved by: Steve Butterfield Date 22/11/18

Fitter(s) Name(s):

Signed Date

7.0 Training Requirements

e) Goggles/protective glasses

e) All waste to be removed from site and disposed of in accordance with Kaydee Blinds waste

procedure.

b) All fitters are trained in the safe use of access equipment

a) All fitters have CSCS card

8.0 Emergency Procedures

a) Supervisor has attended a one day appointed persons course

b) First aid kit located in vehicle

c) Supervisor to notify site office/clients representative and Kaydee Blinds Safety Advisor

Steve Butterfield 01332 851402

5.0 Safety precautions

d) Gloves

c) Hi-vis vest

b) Safety Boots

a) Hard hat

6.0 Personal Protective Equipment (PPE)

d) Where other persons working in vicinity work area to be cordoned off with barriers and tape

and affected persons made aware of work in progress.

c) Materials and equipment to be taken on site when permitted by client and removed at the

end of the working day.

b) Only site access and egress to be used as specified by client, using designated vehicle and

pedestrian routes and parking areas.

a) Site induction to be carried out for all staff 15 minutes minutes prior to work commencing.

Induction starts at 8am

Page 2 of 2

13.0 Example RAMS Document 34


RISK A

SSESSMENT 260417 R

EV3

RISK A

SSESSMENT

Insta

llation o

f blinds (usin

g h

op-u

p) –

new b

uild

Work a

ctivity

Hazards

Risk level

(PxS)

Precautions

Revised

risk level

(PxS)

Installation of blinds –

Hop up detail :

Hop-U

p W

ork

Platform

600mmx600mm

•Aluminium Platform

, Stiles

& R

ungs

•Max. Safe W

ork

ing Load

150kg

Steel lockable hinges and

anti-slip feet.

Falls fro

m height

Medium

2x5=10

Hop-u

p to be checked before

use and on a

weekly basis and record

ed

Hop-u

p to be ere

cted on level surface

Low

1x5=5

Falling objects

Medium

2x5=10

Head pro

tection to be w

orn

Safety footw

ear to

be w

orn

Care

to be taken w

hen carrying tools and

materials

Low

1x5=5

Manual handling

Medium

3x4=12

Fitters tra

ined in safe m

anual handling

techniques

2 Fitters to lift heavy items w

here

required

Low

1x4=4

Power to

ols

Medium

3x4=12

Battery

opera

ted hand tools used only

Mains-fed battery

charg

ers Portable A

ppliance

Tested

Equipment to

be checked before

use

Eye pro

tection to be w

orn

Daily Personal Noise Exposure

s below

First Action Level 80 dB(A

)

Exposure

to hand arm

vibra

tion below

Exposure

Action Level

Low

1x4=4

Assessor: STEVE B

UTTERFIELD

Sig

natu

re:

Date

:22.1

1.2

018

Severity

Trivial

Minor Injury

Over 3 day

injury

Major Injury

Incapacity or

death

Probability

1

2

3

4

5

Very High 6

6

12

18

24

30

High 4

4

8

12

16

20

Medium 3

3

6

9

12

15

Low 2

2

4

6

8

10

Very Low 1

1

2

3

4

5



RISK A

SSESSMENT 260417 R

EV3

RISK A

SSESSMENT

Insta

llation o

f blinds (usin

g ste

pla

dders) –

new b

uild

Work a

ctivity

Hazards

Risk level

(RxS)

Precautions

Revised

risk level

(RxS)

Installation of blinds

Falls fro

m height

High

3x5=15

Stepladders to be checked before

use

Ensure

stepladders on firm and level surface

Fitters not to

step above last tw

o rungs

Fitters not to

overreach

Medium

2x5=10

Falling objects

Medium

2x5=10

Head pro

tection to be w

orn

Safety footw

ear to

be w

orn

Care

to be taken w

hen carrying tools and

materials

Low

1x5=5

Manual handling

Medium

3x4=12

Fitters tra

ined in safe m

anual handling

techniques

2 Fitters to lift heavy items w

here

required

Low

1x4=4

Power to

ols

Medium

3x4=12

Battery

opera

ted hand tools used only

Mains-fed battery

charg

ers Portable A

ppliance

Tested

Equipment to

be checked before

use

Eye pro

tection to be w

orn

Daily Personal Noise Exposure

s below

First Action Level 80 dB(A

)

Exposure

to hand arm

vibra

tion below

Exposure

Action Level

Low

1x4=4

Assessor: STEVE B

UTTERFIELD

Sig

natu

re:

Date

:22.1

1.2

018

Severity

Trivial

Minor

Injury

Over 3

day injury

Major

Injury

Incapacity

or death

Probability

1

2

3

4

5

Very High 6

6

12

18

24

30

High 4

4

8

12

16

20

Medium 3

3

6

9

12

15

Low 2

2

4

6

8

10

Very Low 1

1

2

3

4

5



14.0 Accident Reporting Procedure

In the event of an accident at work, all accidents are recorded and investigated, and appropriate action taken to prevent re occurrence.

We look at the training of the staff, equipment and procedures used within that working activity. Any issues will then be resolved speedily and effectively.

All accidents/incidents are then recorded in an Accident Book. An example of a actual incident is recorded on our Accident Form within this section.

We are instructed to report all accidents to our external Health & Safety consultancy, Citation plc, and follow the procedure on the flow chart enclosed.

Kaydee had also introduced a system in March 2012 for recording Near Misses. All accidents/Near Misses etc are recorded as Non- Conformities to be resolved in accordance with ISO OHSAS 18001 measures.

THE COMPANY ALSO HAS 3 TRAINED FIRST AID APPOINTED PERSONS BASED AT OUR OFFICE.

37


14.1 Accident Reporting Flowchart

Dangerous occurrence

Work related illness or diseaseAccident or assault

Notify the senior person present

Employee to notify management

Notify the senior person present

Take appropriate action to make the area safe

Identify causative factors and controlfurther exposure

Administer first aid and call emergency services, if required

Investigate the incident and

document the findings

Complete the accident book, investigate and


Complete the accident book, investigate and


If reportable (contact Citation plc’s advice line if unsure), complete the relevant online HSE RIDDOR reporting form.*

Review risk assessments to ensure they are adequate and take into account the cause of the incident

Discuss at management level and communicate to employees any additional controls or limitations

To prevent a recurrence, implement actions and monitor

*Note the Incident Contact Centre telephone reporting service is only available for major injuries and fatalities on 0845 300 9923.

38


14.2 Accident Reporting Form

1. About the person who had the accidentName xxxxxxxAddress & Post Code xxxxxxOccupation: Warehouse Operative on contract

2. About the person filling in this formIf you did not have the accident, write your address and occupationName xxxxxxxAddress & Post Code xxxxxxOccupation: Administrator for Sayfa Systems UK Ltd

3. About the accidentWhen did it happen? Tuesday afternoon, 26th February 2013Where did it happen? In the Warehouse at Sayfa Systems, ShepshedHow did it happen? Operative using Cut Off saw, cutting up pieces of Unistrut metal.Give the cause if possible: Saw blade appears to have become ‘jammed’, forcing operative’s left hand up, knocking it against the machine, damaging index finger and nail. On inspection by xxxxx , Senior Warehouse Operative, blade was worn. All PPE kit was being worn at the time. xxxxx has been trained in basic use of the machine. The blade was replaced immediately, and the machine checked, the task was then completed by xxxxxx. Checked with xxxxx & xxxxxx that details of accident are correct.If the person who had the accident suffered an injury, what was it?Cut sides of upper joint of first finger on left hand. Most likely will loose nail on that finger.What were the consequences of the injury? Operative visited casualty dept of local hospital. The finger was not fractured, nor did it need stitches. Anti septic wipes applied to finger and bandaged by medical staff. xxxxx is to return to hospital for bandages to be changed on Monday 4th March, on pain killers after incident. xxxxx given lighter duties in the warehouse- cleaning and TIG weld etc. (TIG Training & Assessment already completed). Recommend: 1. To monitor xxxxx’s recovery & to ensure duties fit around the injury at present. 2. To carry out Risk Assessment for this activity.

Sign the record and date it.

Signature ...................................................................................................................................................................... Date: 28 2 2013

4. For the employee onlyI give my consent to my employer to disclose my personal information which appear on this form to safety representatives and representatives of employee safety for them to carry out the health & safety functions given to them by law. Tick this box if you give your consent.

Signature ...................................................................................................................................................................... Date: 28 2 2013

5. For the employer onlyComplete this box if the accident is reportable under the reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR)How was this reported?

Date reported .......................................................................................................................................................... Signature ......................................................................................................................................................................

Report No: 00002

ALL Accident Records should be returned to the H & S Administrator for filing.

39


15.0 CIS 40