Permission to Access High Hazard Space Request Form

This permission request form must be completed and submitted 72 hours prior to the start of the requested activity. This will enable the appropriate space owner to make the space safe to enter. High Hazard spaces are as definded it the QuEMIS Hazard Management System.

Department where activity is to take place

Excluding Chemistry, Engineering, Life Sciences, Physics, WMG and Warwick Medical School

Room Number If plant area, provide appropriate description

Work reference number (where available)

Survey

Maintenance activity

Project

Other (give details in box below)

Additional Information

Work to be carried out in the space (Indicate if this is in a plant room affecting the lab/workshop operation)

Date access is required

Required start time of activity

Required end time of activity (must be less than 24 hrs)

Names of people attending the space

Person requesting access to the space

Company name and contact details (or Estates staff, include their contact number)

Person completing form You may be contacted for further information

Privacy notice

This data on this form will be used to ensure appropriate actions and authorisations are taken to grant access (as appropriate) to high hazard spaces

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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Permission to Access High Hazard Space Request Form

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