Mensura External Service forRegistered office:T +32 2 549 71 00Bank account: 310-0800020-50
Prevention and ProtectionZaterdagplein 1F +32 2 223 52 50IBAN:BE86 3100 8000 2050 - BIC:BBRUBEBB
at Work non-profit organisation.B-1000 BrusselsEE: 0410.664.742
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1. Employer identification
Company Name: ...... Subscription number:
Address of the registered office: ......
......
Address of the company’s headquarters: ......
......
Correspondence address: ......
......
Places of business to which the subscription agreement applies:
Designation: ......
Address: ......
......
......
CBE No. : ...... VAT No. : ...... NOSS no. : ......
Telephone: ...... Mobile phone: ......
Fax: ...... E-mail: ......
Business sector (accurate description of the business activity (or activities)):
......
......
NACE-BEL code: ......
At the time the identification document is compiled, the company belongs to group A/B/C+/C- or D in accordance with Article 3 of the Royal Decree of 27/09/98 - Belgian Official Gazette 31/03/98 (ISPP):
Name of the person responsible for day-to-day management:
......
Name and training of the person responsible for the Internal Service for Prevention and Protection at Work:
......
Trade union delegation: yes / no
Committee for Prevention and Protection at Work yes / no
Days and times of the meetings held by the Committee for Protection and Prevention at Work:
......
Advice from the Committee for Protection and Prevention at Work related to:
distribution of tasks for the ISPP (internal service) and ESPP (external service) (date): ......
2. Responsibilities and tasks of the EXTERNAL Service for Prevention and Protection
Providing support to the employer, the hierarchical line and employees with regard to dynamic riskmanagement / ERisk analysis: assisting in the identification of hazards, providing advice regarding the results of the risk analysis and advice with respect to the proposed measures, providing advice related to the global health and safety plan and annual action plan[2] / E
Investigating serious occupational accidents in accordance with Royal Decree of 27/03/98 and all amendments thereto / E
Participating in the analysis and investigation of causes of occupational illnesses[3] / E
Investigating occupational accidents and incidents (resulting in absence from work lasting four days or more - general inspection during the annual company visit) / E
Investigating and preventing harassment at work (bullying, sexual harassment and violence at work) / E
Responsibilities reserved for the Safety Officers in the medical supervisiondepartment:
- Examining the correlation between person/work
- Ensuring supervision of employees’ health:
- avoiding a situation where employees are performing jobs that are unsuitable
- promoting employment for everyone
- identifying occupational illnesses and informing employees
- Monitoring the organisation of First Aid services
- Reporting occupational illnesses
Company visit in accordance with the statutory frequency. / E
3. Responsibilities and tasks of the INTERNAL Service for Prevention and Protection
The tasks that must be legally performed by the internal service are indicated with an I. For some tasks there is a choice: these are either performed by the internal service or the external service (I/E: delete as applicable). These tasks are performed by the internal service unless it is explicitly indicated below that they are performed by the external service. If the latter applies this allocation of tasks is only valid if this document is signed and dated by the company and by the external service.
-Responsibilities and tasks related to the dynamic risk management system:
Participating in the analysis and investigation of causes of accidents and incidents / I/EAssisting in the investigation of workloads, ergonomics and psychosocial factors / I/E
Advice related to workplaces, workstations, environmental factors, physical, chemical, carcinogenic and biological agents, work equipment and individual equipment / I/E
Advice related to hygiene in the workplace + social services / I/E
Advice related to instructions: the use of work equipment, the use of chemical and carcinogenic substances, biological agents, the use of collective and personal protective equipment, fire prevention, procedures in the event of serious and immediate danger / I/E
Advice related to training employees: when they first take up their duties or if they are transferred or change jobs, when there is new or modified work equipment, when new technology is introduced / I/E
Making proposals for welcoming, informing, training and raising awareness / I/E
Advice on all matters, measures or methods related to well-being / I/E
Participating in the coordination of external companies / I/E
Being at the disposal of the employer, the hierarchical line and the employees / I/E
Assisting with emergency procedures and the application of urgent measures /
I/E
Assisting with the organisation of First Aid services / I/EPerforming all other statutory tasks / I/E
In order to fulfil these responsibilities, the Safety Officers are responsible for performing at least the following tasks:
-As part of the permanent risk analysis and global and annual health and safety plan:
Frequent and systematic assessments of the workplace / I/EAssessment of workstations in the event of increased or new risks / I/E
Comprehensive assessment of workplaces at least once a year / I/E
Investigating occupational accidents and incidents (all occupational accidents except those classified as serious) / I/E
Research into well-being / I/E
Performing or commissioning analyses or checks / I/E
Examining working methods and manufacturing processes and proposing measures / I/E
Keeping documentation / I/E
Taking measures oneself in the event of an emergency and the management’s absence / I
-As part of the service’s management and operations:
Compiling monthly or quarterly reports / I/ECompiling annual reports (each year the section from the external service for prevention and protection is supplied automatically) / I/E
Compiling occupational accidents data sheets / I/E
Compiling and endorsing documentation related to work equipment and personal protective equipment (Occupational Physician’s approval is compulsory) / I/E
Maintaining documents for the authorities / I/E
Secretariat work for the Committee / N/A
-Additional tasks for the internal service for prevention and protection:
Organising cooperation with the external service / IProviding the external service with any necessary and useful information / I
For risk analysis: cooperating with the external service / I
Assisting the external service in the implementation of preventive measures / I
Assisting in the development of procedures for serious hazards, organising the First Aid service and emergency care / I
First Aid in the event of an accident or illness / I
4. Organisation of the INTERNAL Service for Prevention and Protection
- Composition of the internal service, the number of Safety Officers, their qualifications and duration of theirservice:
Is the head of the internal service for prevention the employer? Yes / No
Name of the internal Safety Officer / Duration of his/her service [4] / Qualifications [5]- The skills that are represented internally so that the tasks can be fully and effectively carried out[6]:
- The administrative, technical and financial resources[7]
-Administrative resources:
-Technical resources:
-Financial resources:
5. External Safety Officers
The experts at the Mensura External Service for Prevention and Protection at Work (non-profit organisation) will support the employer in the implementation of the following responsibilities and tasks.
Discipline: Medical supervision
-Investment in time: depends on the number of employees concerned
-Occupational Physician: <name>
-Company visitor: <name>
Discipline: Psychosocial stress
-Investment in time: depends on the complaints related to harassment
-Safety Officer for psychosocial support: <name> [8], please refer to the attached list of Psychosocial Safety Officers
Discipline: Occupational safety (compulsory: investigation of serious occupational accidents, optional: other tasks)
-Investment in time: depends on the number of serious occupational accidents and any other assigned tasks
-Position: Level I Safety Officer (for investigating serious occupational accidents) or Level II safety for other tasks
Discipline: Ergonomics
-Investment in time: at the request of the internal service or depending on the assigned aforementioned tasks
-Position: Safety Officer or deputy Safety Officer for Ergonomics
Discipline: Occupational hygiene
-Investment in time: at the request of the internal service or depending on the assigned aforementioned tasks
-Position: Safety Officer or Deputy Safety Officer for Occupational Hygiene
Discipline: Occupational healthcare (above all First Aid training)
-Investment in time: at the request of the internal service or depending on the assigned aforementioned tasks
-Position: Safety Officer or deputy Safety Officer for Occupational Healthcare
This identification document remains valid subject to requests and/or services that are accepted by mutual consent by both parties, as an appendix to this identification document or if a new identification document is agreed that cancels or replaces the previous one.
Drawn up in good faith in ...... on ......
In two copies whereby each party declares that it has received, read and approved its own copy.
Name and signatureEng. Karine Eerdekens
Company representativeRisk Management Director
Mensura External Service forRegistered office:T +32 2 549 71 00Bank account: 310-0800020-50
Prevention and ProtectionZaterdagplein 1F +32 2 223 52 50IBAN:BE86 3100 8000 2050 - BIC:BBRUBEBB
at Work non-profit organisation.B-1000 BrusselsEE: 0410.664.742
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[1]Identification document in accordance with Article8 of the Royal Decree of 27 March 1998 relating to the internal service for prevention and protection at work - Belgian Official Gazette 31/03/98
Classification of companies / Internal serviceHead / Safety Officer
Group A / Level I / Level II
Group B / Level II / Basic knowledge
Group C + / Level II / Basic knowledge
Group C - / Basic knowledge / Basic knowledge
Group D / Basic knowledge / -
[2]Please note:Providing advice means:reviewing a risk analysis, global health and safety plan or annual action plan compiled by the internal service and making adjustments where necessary.If the External Service for Prevention and Protection must compile these documents then this constitutes a separate assignment and is not included in the flat fee.
[3]Legally you have a choice.Mensura External Service for Prevention and Protection however considers this to be one of the standard duties of the Occupational Physician.We also consider it as one of the external service’s tasks and it is therefore not subject to an additional charge.
[4]% of the full-time position that will be spent on the tasks of the internal Safety Officer.
[5]If the Safety Officer has relevant qualifications and/or experience relating to safety, mention this here.
[6]A complete internal prevention service must possess the following skills or be able to call on employees from a different company department who possess these skills:
-Knowledge relating to occupational safety
-Knowledge relating to occupational medicine
-Knowledge relating to ergonomics
-Knowledge relating to occupational hygiene
-Knowledge relating to psychosocial aspects of labour including bullying, sexual harassment and violence in the workplace.
The scope of the required skills must be considered in relation to the size of the company and the specific risks involved in the business.A company that does not possess one or more of these skills must enlist the help of an external service.This must be explicitly mentioned in the identificationdocument.
[7]Some examples. Administrative resources: a part-time secretary.Technical resources: measuring apparatus.Financial resources:an estimate of the budget for the internal prevention service.
[8]Legislation requires that the Psychosocial Safety Officer(s) working for your company be mentioned in the identification document and in your employment regulations (or an appendix thereto).In attachment you will find the complete list of PsychosocialSafety Officers.The one who is underlined is designated as your single point of contact.The others must also be mentioned in the event that your permanent Safety Officer is absent.For the sake of completeness the Safety Officers for the two national languages are mentioned.If your employees all belong to one linguistic group only, mentioning the employees for that language group in your documents is sufficient.