“This is to declare that I have been briefed about the basic safety requirements to be followed while being

at site. I will exercise enough care, which is expected from a normal person to safeguard others and myself.
I will be responsible for any of the mishaps occurring due to my negligence and carelessness at site. I
agree to follow all the safety precautions told to me with specific reference to the following:

 Usage of safety helmet and safety shoes in plant area;

 Not entering the hazardous areas, which are barricaded or provided with sign boards prohibiting
entry;
 Not entering areas other than authorized to me, which are related to my work;
 Not interfering with the operation of any of the equipment or any production machinery;
 Following the speed restrictions in the project;
 Complying with any other safety signs displayed at the project area.

Name : …………………………....... Signature : ……………………..

Company : ……………………………………

Date : ………………………….. Time : ……………….

(ORIGINAL COPY OF THE DECLARATION TO BE KEPT BY THE PLANT OFFICE

SECRETARY)