Telecom Tower Health & Safety Access Declaration
Personal & Company Information
Full Name
Company Name
Contact Number
Email Address
Site Name / Tower Location
Date of Visit
Time of Entry
Anticipated Time of Exit
Access Purpose & Details
Purpose of Visit
Work to be Undertaken
Names of Team Members (if any)
Health & Safety Declaration
I hereby confirm that:
I am trained and certified to access telecom tower sites.
I will use all required Personal Protective Equipment (PPE).
I have conducted / reviewed site-specific risk assessment.
I will adhere to all health & safety procedures while on site.
I will promptly report any incident, near-miss, or hazard encountered.
Additional Comments / Notes
Signature
Date