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Visitor Safety Declaration

The visitor safety declaration is signed at the security gate or reception by anyone visiting a plant, warehouse, lab or office: clients, auditors, vendors, interview candidates or family members. It records the visitor and host, confirms a short safety briefing, and commits the visitor to stay with the host, wear PPE and follow emergency instructions.

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[Company Logo][Company Name]

VISITOR SAFETY DECLARATION

Visitor Pass No.:: [Reference Number]
Date:: [DD/MM/YYYY]
Time In:: [Time]
Time Out:: [Time]

Visitor Details

Name
Organisation
Mobile Number
ID type and last 4 digits
Purpose of visit
Areas to be visited
Vehicle number (if any)

Host Details

Host Employee Name
Department
Extension / Mobile

Safety Briefing Received

Emergency alarm sound and what to do
Nearest exits and assembly point: [Assembly Point Location]
Marked visitor walkways to be used
Restricted areas not to be entered
No smoking or naked flames anywhere on premises
Report any injury or feeling unwell to the host immediately

PPE Issued

Safety helmet
Safety goggles
Safety shoes / shoe covers
Ear plugs
Hairnet / gown (clean or food areas)
Reflective jacket

Health Check (food, pharma or clean areas only)

Any fever, cough, stomach infection or open wound? (Yes / No)

Visitor Declaration

I will remain with my host at all times and use only marked walkways.
I will wear the PPE issued to me in all areas where it is required.
I will not take photographs or videos without written permission from the host.
I will not touch, operate or lean on any machine, panel or material.
In an emergency I will follow the instructions of the host and safety marshals.
I will keep confidential any process or business information I see during the visit.
I will return the visitor pass and PPE at the gate when leaving.

Visitor
[Visitor Name]
Date: [Date]

Host
[Host Employee Name]
Date: [Date]

Security
[Security Guard Name]

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What this template includes

Visitor identification and purpose of visit
Host employee who is responsible for the visitor
Short safety briefing checklist
PPE issued at the gate
Rules on photography, mobile phones and restricted areas
Emergency instructions and assembly point
Health self-check for food or clean-room areas

When to use it

Client and auditor visits to a manufacturing plant
Vendor and service engineers visiting for a few hours
Students and interns on industrial visits
Interview candidates taken on a shop-floor tour

How to customise this template

1Print the plant's key safety rules on the reverse of the form
2Add a site map with visitor walkways highlighted
3Set PPE to be issued by visit area
4Add a confidentiality line for R&D or pharma areas
5Store forms with the visitor register for the period your policy requires

HR tips

Never let visitors move around the shop floor alone
Collect PPE and the visitor badge at exit
Ask only for ID type and last 4 digits, not full Aadhaar
Carry the visitor register to the assembly point during drills

Occupiers have safety responsibilities toward everyone on their premises; this form supports good practice but verify site-specific requirements under applicable safety, fire and data protection rules.

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Frequently asked questions

Why should visitors sign a safety declaration?+

It confirms they were briefed on hazards and rules, helps account for them in an emergency, and sets clear expectations on PPE and restricted areas.

What ID details should we collect from visitors?+

Collect the type of ID and the last 4 digits or a masked copy. Avoid storing full Aadhaar numbers.

Do office visitors need a safety declaration?+

A shorter version is useful in offices too, especially for emergency headcount, but plants and labs need the full form.

All 50 posh, workplace safety & compliance →

[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

Agreement · Word

Contractor 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:
Form · Word
POSH Confidentiality Declaration
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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
Policy · Word
Workplace Safety Policy
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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
Form · Word
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
Register · Word
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
Register · Word
Fire Safety Training 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)
Form · Word
Employee Health Declaration
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