Sample form: Indemnity agreement - South of Africa



Sample form: Indemnity agreement

INDEMNITY AGREEMENT

VISITORS

|Name & surname (please print) | |

|Company | |

|Vehicle registration | |

|Time in: |Time out: |

|Signed at |Date: |

THESE RULES HAVE BEEN DRAWN UP FOR YOUR PROTECTION IN THE INTEREST OF

HEALTH, SAFETY AND PROTECTION OF THE ENVIRONMENT; AND AS REQUIRED IN TERMS OF CONSTRUCTION REGULATION CR 7(8) OF THE OCCUPATIONAL HEALTH & SAFETY ACT.

Adhere to all speed limit restriction signs and do not exceed 20km/h on temporary roads.

Obey all warning and information signs and pictograms – especially those relating to the use of protective clothing and equipment.

Beware of excavations, some of which may not be clearly demarcated.

Beware of overhead work – including cranes and batch plant operation.

On visiting contractor’s site within the _______________________________________site precinct, report to the contractor or the contractor’s representative.

Report any accident or incident to the Site Manager (______________________).

The site contains construction machinery, moving vehicles and equipment. Please proceed

with caution to avoid accidents.

Observe all fire precautions. Fires may only be lit in designated areas.

All vehicles are subject to random searches by Security upon leaving the premises.

The ________________________________________ Company reserves the right of admission.

Random searches may be carried out by Security staff on your entering or leaving the

premises.

Admission to this site is strictly controlled as required by the Occupational Health and Safety Act.

I, the undersigned, _______________________________(name as stated above), having been given permission to enter the property managed by ___________________________________ and recognising the inherent hazards that exist on premises of this nature, hereby acknowledge that I enter the said property entirely at my own risk and that I shall have no claim against the company or any of its employees, agents or mandatories for any loss, damage or injury whether such loss, injury, accident or damage is a result of any negligent act or omission on the part of the company or any of its employees, agents, mandatories or independent contractors or by way of the use of defective materials or equipment supplied by the company or by way of any human or mechanical error, default or failure occurring on the said property or whether such accident or injury or damage occurs from any other cause, nothing at all excepted.

SITE RULES

All visitors must sign the register in place at the relevant site offices prior to leaving the site.

Signed ______________________________________

Date __ ____________________________________

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