This form is to be completed by the club manager to verify that an empliyee is capable of the below
Employee Name *
Date *
Gym Location
Donnybrook
Sandyford
Has the worker received suitable training to carry out the task or activity?
Yes
Is the worker medically fit to undertake the task?
Yes
Has the worker sufficient information about the job, equipment or substances?
Yes
Does the work involve handling dangerous equipment or substances that require supervision?
No
If cash is being handled, will they be at risk of violence?
Yes
Have they been fully trained in strategies for the prevention of violence?
No
Do they know how to control and defuse potentially violent situations?
No
Is there adequate provision for first aid?
Yes
Does the worker have the appropriate PPE and are they trained in its use?
Yes
Are there facilities to be able to contact the worker at all times?
Yes
Are there suitable arrangements for the worker in the event of an emergency?
Yes
Have plans been made to keep in touch with colleagues?
Yes
Is there a means for them to contact line managers, including an alternative?
Yes
Are they in possession of emergency contact numbers?
Yes
Is the access to, or exit from, the workplace safe and well lit?
Yes
Does the workplace present special risks for someone on their own?
Yes
Do the arrangements cover out of hours working?
Yes
Manager sign off *
Submit
