Document 16050371

Working Alone Outside Normal Hours in Laboratories in Merz Court
Postgraduate student / Postdoctoral researcher / Staff declaration
NOTE: Working alone outside normal hours in laboratories without an additional
appropriately skilled person present is a potentially very hazardous practice and must
not be undertaken.
For this reason this declaration must be renewed weekly
A full Risk Assessment (completed by the supervisor) must be attached to this form.
You must nominate someone who will be in regular contact with you during the period
you are working alone out of hours.
Additionally you MUST complete the declaration on the Safe Work Out of Hours
To be completed by the researcher:
Dates and times of intended work (as declared at
Reason for working outside normal hours (print clearly using black/blue ink):
If necessary continue on back of form
Risk Assessment attached:  (please tick)
Please give the name of the appropriately skilled person who will be in contact with
you. State the name, method of communication and frequency of communication:
I have read and understand the HSE leaflet: “Working alone, Health
and safety guidance on the risks of lone working”
See: (
 (please tick)
Declaration to be completed by the responsible supervisor:
I agree that it is necessary to carry out this work outside normal working hours. I have
reviewed the above provisions and regard them as satisfactory for safe working in the
laboratory named above.
Supervisors are reminded that they are legally responsible for the accuracy of the completed
form and any consequences that may occur.
A copy of this declaration should also be given to the School Safety Officer
Document Working Alone Out of Hours: V01 May 2016