Free agreement template · Word

Contractor Safety Declaration

The contractor safety declaration is a signed undertaking by a contractor or vendor before its workers start at your premises. It commits the contractor to follow site safety rules, deploy trained and fit workers with PPE, take work permits, maintain insurance and statutory coverage, and report incidents immediately.

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[Company Logo][Company Name]

CONTRACTOR SAFETY DECLARATION AND UNDERTAKING

Ref. No.:: [Reference Number]
Date:: [Date]
Work Order / PO No.:: [Reference Number]

Contractor Details

Contractor / Firm Name
Address
GSTIN
Contract labour licence no. (if applicable)
ESI code / PF code
Contact person and mobile
Contractor safety supervisor name

Scope of Work

Description of work
Location within premises
Start date and expected end date
Maximum number of workers
Hazardous activities involved (hot work / height / electrical / confined space / chemicals / lifting)

Undertaking

We, [Contractor Name], engaged by [Company Name] for the above work at [Work Location], undertake as follows:

We have received and understood the site safety rules and will ensure every worker attends site induction before starting work.
We will deploy only workers who are competent, medically fit and above the legal minimum age, including licensed electricians, welders and operators where required.
We will provide each worker with suitable PPE free of cost and ensure it is worn at all times.
We will obtain work permits from [Company Name] before any hot work, work at height, confined-space entry, electrical isolation or excavation.
We will use only tested and safe tools, ladders, scaffolds and lifting equipment, with test certificates available on request.
We will maintain ESI / PF coverage or valid employee compensation insurance for all deployed workers, and share proof of payment on request.
We will keep our work area tidy, remove waste daily and not store flammable materials without permission.
We will report every incident, injury or near-miss to [Company Name] immediately.
We accept that [Company Name] may stop work or remove any worker from site for safety violations.
We will comply with all applicable laws, and this undertaking is in addition to the terms of the main contract.

Documents Submitted

List of workers with ID proof (masked Aadhaar / other ID)
ESI / PF registration and latest challan
Insurance policy copy
Licences of specialised workers
Equipment test certificates
Method statement / risk assessment for the job

For [Contractor Name]
[Name of Authorised Person]
[Designation]
Seal and Signature
Date: [Date]

Accepted for [Company Name]
[Authorised Signatory]
[Designation]
Date: [Date]

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What this template includes

Contractor and scope-of-work details
Numbered undertakings on rules, PPE, permits and supervision
Worker competence and fitness, including licensed electricians and operators
Insurance and ESI / PF coverage for deployed workers
Incident reporting and stop-work authority
Consequences of breach, including removal from site
Reference to the main contract

When to use it

Before civil, electrical, painting or fabrication contractors begin work
Onboarding housekeeping, security or canteen vendors
Annual renewal for long-term facility management contracts
Before short jobs such as AC servicing, roof repair or tank cleaning

How to customise this template

1Attach your site safety rules booklet as an annexure
2List the permits required for this scope (hot work, height, confined space, electrical)
3Specify insurance types and minimum cover as per your contract
4Require a named contractor safety supervisor for larger jobs
5Align the penalty and termination clause with the main contract

HR tips

Give site induction to every contractor worker before work starts
Check licences of electricians and crane operators physically
Verify ESI/PF challans of the contractor periodically
Stop work immediately on serious violations; do not wait for the end of day

Principal employers have responsibilities for contract workers under the OSH Code, 2020, the Code on Social Security, 2020 and related rules (in force from 21 November 2025, with rules being notified); review this declaration alongside the main contract with a legal adviser.

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Frequently asked questions

Why should a contractor sign a safety declaration?+

It documents that the contractor understands and accepts your safety rules and obligations before work starts, which helps prevent incidents and clarifies responsibility.

Is the principal employer responsible for contractor worker safety?+

The principal employer has important duties for safety and welfare of contract workers on its premises, alongside the contractor. Check current law for the exact scope.

Does this replace the contractor agreement?+

No. It supplements the main contract or work order, which should contain commercial terms, indemnity and termination provisions.

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Visitor Safety Declaration
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[Company Logo][Company Name]
CONFIDENTIALITY DECLARATION – POSH PROCEEDINGS
Company:
[Company Name]
Complaint Ref. No. (if specific):
[Reference Number]
Date:
[Date]
Signatory Details
Name
Employee ID / Organisation
Designation
Contact Number
- Presiding Officer / Member of Internal Committee
- External Member
- Complainant
- Respondent
- Witness
- HR / Administrative support to the committee
- Interpreter / Other (specify)
Undertaking
I, [Name], understand that I have been or may be given access to information relating to a complaint of sexual harassment under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 and the POSH policy of [Company Name]. In consideration of this access, I undertake as follows:
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[Company Logo][Company Name]
WORKPLACE SAFETY POLICY
Policy No.:
[Reference Number]
Effective Date:
[DD/MM/YYYY]
Version:
[Number]
Owner:
[Safety Officer / Admin Head]
1. Purpose
[Company Name] is committed to providing a safe and healthy workplace and to preventing injuries, ill health and damage to property. This policy sets out the minimum safety standards that apply at all our premises and work activities.
2. Scope
This policy applies to all employees, trainees, contract workers, vendors and visitors at [Work Location] and any other premises, sites or vehicles operated by the company, including client sites where our staff are deployed.
3. Definitions
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[Company Logo][Company Name]
HEALTH & SAFETY CHECKLIST
Premises:
[Work Location]
Checked by:
[Employee Name], [Designation]
Date:
[DD/MM/YYYY]
Period:
[Month / Week]
Fire Safety
- Fire extinguishers in place, pressure gauge in green, refill date valid
- Emergency exits unlocked, unobstructed and signed
- Fire alarm / smoke detectors tested this month
- Evacuation plan displayed on each floor
- No storage of combustible material near electrical panels
Electrical Safety
- No loose wires, damaged plugs or exposed cables
- No overloaded multi-plug sockets or daisy-chained extensions
- Electrical panels closed, labelled, with clear access
- UPS / battery room ventilated and dry
First Aid
Checklist · Word
Health & Safety Checklist
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[Company Logo][Company Name]
WORKPLACE SAFETY INCIDENT REPORT
Incident No.:
[Reference Number]
Date of Report:
[Date]
Reported by:
[Employee Name], [Designation]
Part 1 – Incident Details
Date of incident [DD/MM/YYYY]
Time
Shift
Location / area / machine
Department
- Fire / smoke / explosion
- Electrical incident
- Chemical / gas / oil leak or spill
- Equipment, vehicle or machine failure
- Structural failure / falling object
- Injury to person (attach injury report)
- Property damage only
- Other: [Details]
Description: what happened, in sequence
Persons involved (name, ID, employee / contractor / visitor)
Witnesses (name, contact)
Part 2 – Immediate Action
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Workplace Safety Incident Form
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[Company Logo][Company Name]
SAFETY TRAINING ATTENDANCE SHEET
Site / Plant:
[Work Location]
Date:
[DD/MM/YYYY]
Time / Duration:
[Time] / [Number] minutes
Trainer:
[Trainer Name], [Designation]
Language:
[Hindi / English / Regional]
Training Type
- Toolbox talk
- Safety induction (new joiner / contractor)
- PPE use and care
- Machine-specific / LOTO
- Forklift / material handling
- Chemical handling
- Work at height
- Electrical safety
- Other: [Details]
Topic and Key Points
Topic
Key point 1
Key point 2
Key point 3
Questions raised by workers
Attendance
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Safety Training Attendance
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[Company Logo][Company Name]
FIRE SAFETY TRAINING RECORD
Premises:
[Work Location]
Training Date:
[DD/MM/YYYY]
Duration:
[Number] hours
Trainer:
[Trainer Name], [Fire Safety Agency / Fire Officer]
Training Type:
[Awareness / Fire Marshal / Fire Team]
Content Covered
- Causes of fire and fire triangle
- Classes of fire and the right extinguisher for each
- Extinguisher operation using the PASS method
- Hose reel / hydrant operation
- Raising the alarm and calling 101 / 112
- Evacuation routes and assembly point
- Electrical and LPG safety
- Role of fire marshals
Equipment Used in Practical
Type Capacity Quantity Discharged Refill Arranged
ABC dry powder [Number] kg [Number] [Yes / No]
CO2 [Number] kg [Number] [Yes / No]
Water / foam [Number] litres [Number] [Yes / No]
Participant Record
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[Company Logo][Company Name]
EMPLOYEE HEALTH SELF-DECLARATION
Company:
[Company Name]
Date:
[DD/MM/YYYY]
Purpose:
[Shift fitness / Outbreak screening / Travel / Food handling / Emergency info]
Why we ask: This declaration helps us keep you and your colleagues safe. The information will be seen only by [HR Name / Medical Officer], used only for the purpose above, and deleted after [Number] months.
Employee Details
Employee Name
Employee ID
Designation
Department
Work Location
Mobile Number
1. Fitness to Work
- I am currently fit to perform my normal duties
- I have a temporary condition that may affect my work (HR / medical officer will contact me)
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Name
Organisation
Mobile Number
ID type and last 4 digits
Purpose of visit
Areas to be visited
Vehicle number (if any)

Contractor Safety Declaration

Preview of the agreement

Contractor Details

Scope of Work

Undertaking

Documents Submitted

What this template includes

When to use it

How to customise this template

HR tips

Frequently asked questions

Visitor Details

Host Details

Safety Briefing Received

Visitor Safety Declaration

Signatory Details

Undertaking

POSH Confidentiality Declaration

1. Purpose

2. Scope

3. Definitions

Workplace Safety Policy

Fire Safety

Electrical Safety

First Aid

Health & Safety Checklist

Part 1 – Incident Details

Part 2 – Immediate Action

Workplace Safety Incident Form

Training Type

Topic and Key Points

Attendance

Safety Training Attendance

Content Covered

Equipment Used in Practical

Participant Record

Fire Safety Training Record

Employee Details

1. Fitness to Work

Employee Health Declaration

Date of incident [DD/MM/YYYY]
Time
Shift
Location / area / machine
Department

Description: what happened, in sequence
Persons involved (name, ID, employee / contractor / visitor)
Witnesses (name, contact)

Topic
Key point 1
Key point 2
Key point 3
Questions raised by workers

Type	Capacity	Quantity Discharged	Refill Arranged
ABC dry powder	[Number] kg	[Number]	[Yes / No]
CO2	[Number] kg	[Number]	[Yes / No]
Water / foam	[Number] litres	[Number]	[Yes / No]

Employee Name
Employee ID
Designation
Department
Work Location
Mobile Number

Contractor Safety Declaration

Preview of the agreement

Contractor Details

Scope of Work

Undertaking

Documents Submitted

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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