SSC site information form

SSC Site Form

Your name - first then last name: *

Your position: *

Your phone number: *

Multiple numbers if applicable

Your email address: *

Business Unit: *

Responsible manager: *

Name of site/team:

(if applicable)

Site Address:

(if applicable)

Operating hours - Monday to Friday: *

Please include all relevant times for all days and add notes if needed

Operation hours - Saturday: *

Operating hours - Sunday: *

First Responsible Person on site and their phone numbers : *

NB attendance is a must for supervision and monitoring of testing process

Second responsible person on site and their phone numbers : *

NB attendance is a must for supervision and monitoring of testing process

Notification of Random Testing - Possible barriers and suggested alternative arrangements: *

Conditions of entry: *

e.g. visitor sign in

Total staff on site: *

Peak testing time(s): *

Approximate staff numbers: *

Any protective equipment needed:

e.g. safety shoes, safety glasses

Any further issues or comments?:

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