Supplemental Information: ISO 45001 Additional Health & Safety Information

Company Name:

Safety Rep:

Are there any activities covered by your scope which are carried out away from the registration address(es), e.g. depots, warehouses, sites or offices?*

Yes
No

If yes, please give details:

Please list the key Occupational Health & Safety Legislation / Regulations which apply to your business:

Have you been the subject of any Safety related Prosecutions, Penalties, Insurance Claims or Enforcement Notices in the past 12 Months?*

Yes
No

Please provide full details:

Have you had any Reportable Injuries in the past 12 Months:*

Yes
No

Number of Fatalities:

Please enter a value greater than or equal to 0.

Number of Major Reportable Injuries:

Please enter a value greater than or equal to 0.

Number of Minor Reportable Injuries:

Supplemental Information: ISO 45001 Additional Health & Safety Information

Supplemental Health & Safety Form