EXEMPTION FORM FOR WSIB - Magna



EXEMPTION FORM FOR WSIB

I _________________ - as an Independent Contractor claim exemption from WSIB coverage how-ever I fully understand that it is my responsibility to ensure that I provide WSIB coverage for any full time or temporary employees that I hire to conduct work within Dortec premise.

Also I understand that I am required to produce a certificate of insurance for a minimum of $2,000,000.00 liability prior to commencement of any work in Dortec Industries.

Contractor Name

Signature Date

Print Name

M.S.D.S. CONTROLLED SUBSTANCE

INVENTORY CHECK LIST

- FORM MUST BE COMPLETED P R I O R TO WORK COMMENCING.

- LIST ALL M.S.D.S. CONTROLLED SUBSTANCES, WHICH WILL BE BROUGHT ON TO THE PREMISES.

- ATTACH COPIES OF ALL M.S.D.S. SHEETS.

- REPORT ALL SUBSTANCE AND/OR PACKAGING LEFT ON SITE AT DORTEC AT END OF WORK ORDER

| | | | | | | | |

|Name of Substance |M.S.D.S. Sheet|Amount of |Will Un-used |Expected Date |Packaging/ |Amount of |Dortec Person |

| |Attached Y/N |Substance Used |Substance be |of Removal |Container |Substance Left |Responsible |

| | |on Site |Removed From | |Disposition |on Site | |

| | | |Site Y/N | | | | |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

Letter of Agreement

By signing this document I acknowledge that I have read and understand the Dortec Requirements in regards to Health & Safety and agree to conform with all Policies while performing work on Dortec property. My employee’s / Sub. Contractors have also received WHMIS training and are aware of the Occupational Health and Safety Act and applicable regulations for any work being performed.

These Regulations will be reviewed with all representatives and Sub. Contractors of my company who will be involved in work at Dortec Industries.

Failure to comply with Dortec’s Health & Safety Policies may result in termination of the contract.

_________________________________________

_________________________________________

Company & Contractor Name

_________________________________________

_________________________________________

Signature of Contractor

Date

Please return a signed copy of this document to the MRO Buyer at Dortec Industries

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download