## Please watch the following video and complete the safety form below



 

 

 







 

 





 

 





 

 

 

 

 





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 I attest that I have received and understood the introduction to security and its rules - Select -YesNo 

 

 I certify my understanding of safety instructions and protocols specific to this site - Select -YesNo 

 

 I confirm being informed about the personal protective equipment (PPE) required here - Select -YesNo 

 

 I declare having been made aware of any necessary safety permits on this site - Select -YesNoN/A 

 

 I acknowledge that non-compliance with the rules may lead to a warning or exclusion from the site for safety reasons - Select -YesNo 

 



 Name of my VEOLIA contact  

 

 Is a work permit or a certification card required (confined space, work at heigh, Loto...)? If yes, please specify which and discuss of that with your Veolia contact - Select -YesNo 

 

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