Safety Statement info needed. Let’s complete the form below so we can commence the creation of your site-specific Safety Statement File. Safety Statement creator Business entity name Business address Name of premises Number of employees Owners name Owner's contact number Health & Safety Manager's name Health & Safety Manager's number HR Manager's name HR Manager's number Health & Safety Representative's name Health & Safety Representative's number Name of First Aider Assembly point for evacuations Does the premises have any of the following non-standard hazards? Does the premises have any of the following non-standard hazards? Bulk Boiling Pan Deep Fat Fryer Goods Lift / Dumb Waiter Mincer Slicer / Shredder Steaming Oven Are there any other unusual hazards? Example: Spiral staircase 3 + 13 = Send for creation