Third Party Occupancy – Health and Safety Checklist
Flow Diagram
Property Team issues Third Party Occupancy – Health and
Safety Checklist as part of annual renewal process or new license agreement
Third Party Occupier completes Third Party Occupancy –
Health and Safety Checklist and returns to Property Team
Property Team forward Third Party Occupancy – Health and
Safety Checklist to OHSS
OHSS review Third Party Occupancy – Health and Safety
Checklist and contacts Third Party Occupier as necessary and continues liaison until necessary standards are satisfied
OHSS notifies Property Team that assessment process has been successful/unsuccessful
(
)

Third Party Occupancy – Health and Safety Checklist
Introduction
This form and associated checklists/declarations have been developed to ensure (so far as is reasonably practicable) you are conducting your operations safely and to satisfy the requirements of UK health and Safety legislation.
Important: Failure to complete this form in full (including signatures) may result in your company ’s request to use/let University space(s) being refused.
Contact details
Your name:
Company name:
Contact details:
Location of spaces being request for use/let
Please tell us what you are going to use the space(s) for
Telephone number(s)
Email address
Home address
Building name:
Floor No:
Room No(s)
Lab Office Lab and
Office
Other (please specify)

1 The University is not suitable for the following areas of work

Hazard group 4 biological agents

Manufacture or use of bulk flammable or hazardous substances
If your organisation is involved with any of the following activities/areas of work, or use any of the following substances then you must provide a comprehensive list of all processes and substances along with the relevant risk assessments/COSHH assessments to your University contact in the ESS
Property Section
(This information will then be forwarded to the ESS health and Safety Officer or
Occupational Health and Safety Service as required)

Manufacture, use, storage or disposal of hazard group 2 and 3 biological agents

Manufacture, use, storage or disposal of genetically modified organisms

Manufacture, use, storage or disposal of Schedule 5 substances or agents

Manufacture, use, storage or disposal of chemical weapon substances

Manufacture, use, storage or disposal of carcinogens

Manufacture, use, storage or disposal of nanoparticles

Use, storage or disposal of radioactive substances including:

Open Sources of Radioactivity

Closed Sources of Radioactivity

X-Ray generating equipment

Lasers Class 3 & 4 including Class 1 Laser Products

Nuclear Magnetic Resonance Equipment

Use of highly flammable gases and substances, explosives and gas cylinders
Declaration: My organisation is / is not (delete as appropriate) involved in any of the activities listed above and does not use any of the substances listed.
Name Signature Date
2 General Health and Safety Requirements
Health and Safety Policy
The University requires all 3 rd party occupiers to have a written health and safety policy, if you do not have a policy but need one use this link to the Health and Safety
Executive (HSE) Website where you will be able to access further information about the management of health and safety including health and safety policy template http://www.hse.gov.uk/toolbox/index.htm

3 Competent Health and Safety Advice
As an employer you must have someone competent to help you meet your health and safety duties. A competent person is someone with the necessary skills, knowledge and experience to manage health and safety.
You could appoint (one or a combination of):
 yourself;
 one or more of your workers;
 someone from outside your business, this link will take you to an approved list of consultants http://www.oshcr.org/
In the box below please provide the contact details of who it is that provides your competent health and safety advice, please also attach an up to date copy of that persons CV.
4 Suitability of Space for Intended Use
(Reference assessment process in Third Party Occupancy Policy)
Health and Safety Questions
Yes No N/A
Have emergency procedures for your operations been developed and implemented?
Do you have arrangements in place for providing first aid?
Do you have arrangements in place for assessing risks arising from your operations?
Do you have arrangements in place for identifying and providing necessary health and safety training?
There is a duty placed on occupiers of shared premises to co-operate and coordinate their activities, have you established contact with the School Safety Officers working in your building.