WENZ Health and Safety Submission

WENZ Health and Safety

Information Submitted for Insurance cover
Club/ Group/Individual Details

Group/Club/Individual NameWENZ number
Email
example@example.com
Event Details
Event Name
Event Name
Event Date

MonthDayYear
Date
Person submitting the Health and Safety information

First NameLast Name
Event Venue Details

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please read the WENZ Health and Safety Manual

Health and Safety forms must be completed before the start of the competition. By submitting this form, you aknowledge you understand the Health and Safety requirements and have mitigated any risks identified.

The forms required must be retained for a period of 3 months.
I have read and understand our responsibilities for Health and Safety *

Event *

	Person Responsible	Date completed
Risk assessment and Hazard Board completed
Equipment maintenace log up to date
Incident, Injury procedure and Emergency plan and contact details completed
Volunteer Briefing scheduled
Competitors notified in the Rider notes

WENZ Health and Safety