SITE PASS & SAFETY INDUCTION APPLICATION FORM

This form must be completed in full by Trade Contractor on behalf of the pass applicant and be submitted by the applicant on arrival for
Induction. Presentation of this application other than in the prescribed form will delay the issue of a site pass.
No person will be permitted to work on site without having attended safety induction and having been issued with a site pass. Where
English is not the applicant's first language, a detailed risk assessment to ensure the health and safety of the applicant and others on site
must be enclosed with this form. Where the applicant is under 18 years of age, a Risk Assessment from the company and letter of consent
from the applicants (Parent(s) or Guardian(s) must be submitted when attending the Safety Induction. Evidence of identity (see below) and
current CSCS (Construction Skill Certification Scheme cards or appropriate Trade Card) must be produced by the applicant when attending
the safety induction. By completing and returning this form the Trade Contractor authorises the issue of the site pass to the applicant and
warrants that he (the contractor) is not aware of any medical condition by the applicant which may affect his/her ability to work safely on
site and further warrants that the applicant has the necessary work permit for the United Kingdom.

TRADE CONTRACTOR DETAILS (PLEASE PRINT ALL DETAILS CLEARLY)

Your Company Name:

Sub-Contracting to: Project Title:

(e.g. BP1 Fit Out)
Your Manager‘s Name (Print): Your Manager’s Signature: Date:

PASS APPLICANT DETAILS (PLEASE PRINT YOUR DETAILS CLEARLY)

First Name(s): Surname:
UK Home Address: Date and Place of Birth:

UK Home Phone No:

Mobile Phone No:

UK National Insurance Number:

If under 2 years at the above address, please give previous UK CSCS No:
home address:
Trade (e.g. carpenter, welder etc):
Are You Employed in a Yes
Supervisor/Manager Position? No
Please provide the
1. Photo proof of identity (i.e. Passport or Full UK Driving Licence Photo ID Card)
following ORIGINAL
documents as proof
of identity (One 2. Printed proof of UK National Insurance number (i.e. NI Card, P45, P60, Payslip)

document per proof

3. Printed proof of UK address (i.e. Utility Bill or Bank Statement) – dated within the last 3
please): months
I confirm the accuracy of the above details and the authenticity of the documents provided. I also agree that Canary Wharf Management
Limited may provide this personal data, and any information collected through the electronic site pass system (including turnstile time
records), to any government authority (including law enforcement and immigration agencies), Canary Wharf Contractors Limited (and any
other Canary Wharf group company) and my employer for the following purposes: prevention, investigation and detection of crime and
other violations of UK legislation; apprehension and prosecution of offenders; public and employee safety; monitoring security;
compliance with contractual obligations by trade contractors (including my employer); and confirmation of my attendance on site.

Applicants signature: Date:

H&S INDUCTION (CWCL USE ONLY)

Project Title: Please Select: Fit Out Shell & Core

Inducted By (Print Name): Inducted By (Signature): Date:

PASS OFFICE USE ONLY

PID No: Card No: Expiry Date:
I confirm that the accuracy of the above details have been checked and photocopied
and these copies have been retained on file securely.
Signature: Date:
THE SITE PASS IS ISSUED AT THE DISCRETION OF CANARY WHARF CONTRACTORS LIMITED. AN APPLICATION MAY BE REJECTED WHERE INFORMATION IN THIS FORM
IS MISSING OR UNSATISFACTORY. ALL SITE PASSES REMAIN THE PROPERTY OF, AND MUST BE RETURNED IMMEDIATELY, TO CANARY WHARF CONTRACTORS
LIMITED, WHEN THE APPLICANT IS NO LONGER WORKING AT THE SITE TO WHICH THE PASS RELATES. A CHARGE OF £50 MAY BE LEVIED AGAINST THE TRADE
CONTRACTOR FOR EACH PASS NOT RETURNED.

F-PP-16-02 Rev 13