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reception@rt-is.co.uk
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Sub-Contractors Registration
Step
1
of
10
10%
PERSONAL DETAILS
Surname
Forename/s
Address
Street Address
Town
County
Postcode
Trade
Mobile no.
Email address
N.I. Number
Date of birth
Nationality
Place of Birth
Transport
Yes
No
Verification of Identity: Passport + Utility Bill / Bank Statement / Council Tax
Have you proof of right to work in the UK?
Yes
No
Attach document
Max. file size: 128 MB.
Do you have a criminal record
Yes
No
Details
Have you ever been dismissed for being under the influence of alcohol and/or drugs
Yes
No
Have you been dismissed for any other reason in the past three years?
QUALIFICATIONS & TRAINING
Do you hold any IRSE qualifications?
Yes
No
Provide Copy of Card / Certificates
Max. file size: 128 MB.
Do you possess any rail qualification e.g. PTS, ST1, Lookout, COSS, Eng. Supervisor,etc ?
Yes
No
Provide Copy of Card / Certificates
Max. file size: 128 MB.
Have you completed any other relevent Rail /Sentinel or technical training?
Yes
No
Provide Copy of Card / Certificates
Max. file size: 128 MB.
Do you hold Manual Handling / Emergency First Aid?
Yes
No
Provide Copy of Card / Certificates
Max. file size: 128 MB.
Have you had a Sentinel D&A in the last 3 Months?
Yes
No
Date
DD slash MM slash YYYY
Do you have a current driving licence?
Yes
No
Attach copy
Max. file size: 128 MB.
Expiry Date
DD slash MM slash YYYY
NEXT of KIN
Relationship
Surname
Forename/s
Address
Postcode
Tel No. (Work)
Tel No. (Mobile)
MEDICAL SELF DECLARATION
Do you wear any spectacles or contact lenses
Yes
No
For what reason – e.g. short sight, reading etc
Are you currently taking any medication (Prescribed or over the counter)
Yes
No
Please provide details
Are you register disabled?
Yes
No
Do you have any illness that may affect your ability to work in or around a construction site or the railway
Yes
No
You may be subject to the screening for presence of alcohol and / or drugs on a random basis. Do you object to this?
Yes
No
Name and Address of personal GP
Doctor
Address
Are you currently under any medical serveillance? (i.e. back problems etc)
Yes
No
Do you, or have you ever suffered or attended a doctor/ hospital from any of the following?
Asthma or shortness of breath
Hernia
High/Low Blood Pressure
Stomach Disorder
Fear of Confined Spaces (being in Tunnels)
Liver Disorders
Diabetes (Insulin Dependant)
Amnesia
Epilepsy or Blackouts
Phobia
Heart Related Problems
Drug / Alcohol Addiction
Nervous Disorders
Vibration White Finger
Back or Disc Related problem
Mobility Problems
Do you have any visual problem?
Allergies
Tenisynovitis (Joint Problems)
Kidney / Bladder Disorder
Problems with hearing or your ears
Ringing in the ears or tinnitus
Infections or discharge from your ears
Any operations on your ears
HAND ARMVIBRATION SYNDROME (HAVS CARD)
Did your previous jobs involve the use of vibrating equipment?
Yes
No
Have you ever suffered from your fingers going white on exposure to cold?
Yes
No
Have you ever had tingling or numbness in your fingers after using vibrating equipment?
Yes
No
Are you experiencing any problems with muscles or joints in your hands or arms?
Yes
No
Do you have difficulty picking up small objects such as screws or nails?
Yes
No
Please confirm you have a current HAVS card?
Yes
No
Please attach copy of card
Max. file size: 128 MB.
GENERAL HEARINGHEALTH
Do you have trouble hearing & understanding men’s/women’s voices?
Yes
No
Do you have trouble hearing birds or the wind in the trees?
Yes
No
Do voices sound blurry, like people mumbling?
Yes
No
Do you have trouble following conversation when 2 or more people are talking at the same time?
Yes
No
Do people complain that you have the TV or radio on to loud for them?
Yes
No
Do you need to turn towards those speaking or cup your ears to hear?
Yes
No
Do you frequently have to ask people to repeat themselves?
Yes
No
Do you sometimes miss sounds (heard by others)? i.e. Door Bell or Telephone
Yes
No
Do you have difficulty hearing over increased distances? i.e. Concerts
Yes
No
Does your hearing ever seem out of balance? i.e. Louder on one side than the other?
Yes
No
If you have answered Yes to any of the questions, please provide full details below.
REFERENCES
Company name
Dates/Year Worked
Occupation
Contact name
Position
Address
Telephone Number
Mobile Number
REFERENCES
Company name
Dates/Year Worked
Occupation
Contact name
Position
Address
Telephone Number
Mobile Number
DECLARATION. Read carefully and understand before signing
I declare that the contents of this application form are true , and I confirm I have read /understood and accept the attached RTIS policy pack , Leptopirosis brieifng , Data Protection agreement, Contractor pay arrangement details.
I authorize RT Infrastructure Solutions Ltd to contact my references.
I am fit, well and able to undertake manual work on building, M & E, civil & railway engineering contracts.
I authorize the deduction of equipment, services or training costs from my payments.
I am not suffering from any occupational illness that could affect my ability to perform my duties.
I have never been reprimanded by Sentinel for being under the influence of drugs or alcohol.
I am willing to undertake a drugs and/or alcohol test at any time if requested by RT Infrastructure Solutions Ltd or the client.
I will inform RT Infrastructure Solutions Ltd if I am taking any medication that may affect my ability to undertake my duties.
I will inform RT Infrastructure Solutions Ltd of any hours worked for other employers and will comply with the relevant industry standards relating to working hours.
I will inform RT Infrastructure Solutions Ltd of any changes in my medical condition or my fitness for work.
Date
DD slash MM slash YYYY
Signature
Print
HOURS OF WORK
RT Infrastructure Solutions Ltd will take all measures as far as is reasonably practicable to ensure that all employees and sub-contractors are aware of and adhere to the guidelines for hours of work.
RT Infrastructure Solutions Ltd requires that all employees or sub-contractors shall not:
Work in excess of 12 hours per turn of duty
Work in excess of 72 hours per calendar week
Work more than 13 turns of duty in any 14 day period
Take less than 12 hour’s rest between booking off and on concurrent turns of duty. With the exception of the following circumstances:
Deviation from the above limits will require a Risk Assessment and will affect the Client’s Principal Contractor / Plant Operators License.
Travelling Time
All RT Infrastructure Solutions Ltd employees and contractors who hold a Sentinel card competency or are required to undertake Safety Critical Work on behalf of RT Infrastructure Solutions Ltd will be required to adhere to the following requirement with regard to travelling to and from sites and lodging away:
Travelling each way to and from site should ideally be included in the maximum 12 hours turn of duty.
However where this is not possible, the travelling time must not lead an overall turn of duty time in excess of 14 hours.
All employees and Sub-contractors
Must
inform RT Infrastructure Solutions Ltd of any hours worked for other employers prior to working for RT Infrastructure Solutions Ltd and will ensure they comply with the RT Infrastructure Solutions Ltd policy relating to working hours.
Name
Signature
Date
DD slash MM slash YYYY
E.C. Working Hours Directive
Each employee has the right to work 48 hours per week as a maximum. If you want to work in excess of 48 hours a week you can opt out of this agreement.
I wish to opt out of the E.C. maximum working hour’s directive (I want to work more than 48 hours per week)
Yes
I do not wish to opt out of the E.C. maximum working hour’s directive (I do not want to work more than 48 hours per week)
Yes
Name
Signature
Date
DD slash MM slash YYYY
Data Processing to Comply With GDPR
RT Infrastructure Solutions Ltd holds and processes personal data and information to comply with various regulatory authorities. The allocation of work and processing of payments uses the information provided. All information processes are undertaken in accordance with our data processing terms. RT Infrastructure Solutions Ltd data processing terms have been updated to comply with GDPR and the following data storage limitations rules will take effect from the 25 May 2018 onwards:
If we have processed a placement or payment(s) for you, we will retain your personal data for the duration of your placement and for a period of seven years thereafter for business purpose. At the end of which period it will be deleted from our systems. We are required by regulatory legislation to retain your data for this period and it cannot be deleted.
If we have not processed a placement or payment(s) for you, but you have provided us with your personal data and accepted our data processing terms, we will retain your personal data for a period of three years, at the end of which period it will be deleted from our systems, unless you refresh your agreement to our data processing terms. You can request deletion of your data at any time during this period.
If we have not processed a placement or payment(s) for you, but you have provided us with personal data and not accepted our data processing terms, we will retain your personal data for a period of 12 months, at the end of which period it will be deleted from our systems, unless you indicate agreement to our data processing terms. You can request deletion of your data at any time during this period.
I have read and understand the information detailed above and acknowledged that RT Infrastructure Solutions Ltd will hold my data on their systems as indicated above. I understand I have the right at a later date to change my agreement to how my personnel data is stored and used, and I can request for my data to be removed in accordance with RT Infrastructure Solutions Ltd data processing terms.
Name
Signature
Date
DD slash MM slash YYYY
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