CWHT SITE SURVEY QUESTIONNAIRE For the attention of the Site Safety Manager/ Safety Officer

Please leave blank:

Contact Information:

Main Contractors (PSCS) Name:

Sub-contractors onsite:

Site/Project Name:

Site Address:

Eircode:

Expected Start Date:

Expected Finish Date:

Site contact name/s:

Mobile No/s:

Email Address:

Number of workers expected to partake:

Normal site start time:

Normal site finish time:

Can you please give detailed directions to your site:

Setup Information:

Is there car parking available for our staff?

Yes No

Will site induction and health and safety orientation be required for our nurse/s?

Yes No

If yes to the above, please provide induction/orientation duration and location details, as well any further information that may be required. This will allow us amend the screening timetable on the nurse’s first day on site.

Is the nurse required to wear specific PPE gear?

Yes No

Will our nurse/s require a security pass?

Yes No

If yes to the above where can these be issued?

Are there any special conditions or access arrangements relating to this site?

Please list the languages spoken on site:

Please note that our nurse/s will make contact with the HSO the day before they are due on site to introduce themselves and confirm parking and access arrangements.

CHOLESTEROL

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DIABETES

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BMI

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BLOOD PRESSURE

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