killingworth young peoples club

1

KILLINGWORTH

YOUNG PEOPLES

CLUB

Health, Safety

&

Welfare Policy

Address: Amberley Park, Garth 21, Killingworth, NE12 6SD

Date: 29 October 2015

Next Review Date: 29 October 2016

2

CONTENTS

Terms of Reference

Page

General Statement of Policy

5

1. Safety Personnel

6

2. User Groups

6

3. Communication

6

4. Co-operation & Care

6

5. Staffing

7

6. Training

7

7. Workplace Inspections

7

8. Working Environment

7

9. Manual Lifting and Moving

8

10. Display Screen Equipment

8

11. Equipment Maintenance

8

12. Control of Hazardous Substances

9

13. Smoking Policy

9

3

14. FIRE SAFETY GUIDELINES

9

14.1 Fire Safety

10

14.2 Fire Detection Equipment

10

14.3 Fire Fighting Equipment

10

14.4 Fire Exits

11

14.5 Emergency Evacuation Procedure

11

14.6 Fire and Emergency Procedures

11

ACCIDENTS/FIRST AID

12

15.1 Accident Investigation and Reporting

12

15.2 Reporting Accidents/Concerns

12

15.3 Accident Book/Reporting:

12

15.4 First Aid

13

16. All employees: - Should / Should Not

13

17. Centre Based / Offsite Activities work with young people

13

18. Commitment to Practice

14

4

SUPPORTING DOCUMENTS

Risk Assessment Form

Appendix 1

Safety Certificate

Appendix 2

Application for Membership

Appendix 3

User Group Booking Consent Form

Appendix 4

Consent Form Guidelines:

• Trip/activity

• Trip/activity where contact with water in rivers, ponds or canals is planned

Appendix 5 Appendix 5a Appendix 5b

Appointed Dedicated Person for Health & Safety

Name

Phil Symons

Appointed Dedicated Person for First Aid

Name

John Celino

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Health, Safety & Welfare Policy

Terms of Reference:

Dedicated person for Health and Safety: An employee/volunteer of the Club who

is ultimately responsible for ensuring Health and Safety within the premises.

Dedicated person or First Aid: An employee/volunteer of the club who is ultimately

responsible for ensuring adequate First Aid provision within the premises.

General Statement of Policy

It is the policy of Killingworth Young Peoples Club to comply with the terms of the

Health & Safety at Work etc. Act 1974 and subsequent legislation to provide and

maintain a healthy and safe working environment.

The Club’s health and safety objective is to minimise the number of accidents and

illnesses and ultimately achieve an accident-free environment, through control and

monitoring. All staff/volunteers and management committee will be provided with

such equipment, information, training and supervision as is necessary to implement

the policy and achieve stated objective.

The Club will pay particular attention to the provision of:

• Public & Liability Insurance

• Policies and Procedures

• A healthy working environment

• Safe and suitable resources and equipment

• Sufficient training for staff/volunteers and management committee to ensure

their ability to comply with health & safety regulations and procedures

• First-Aid Kits in all work sites, mini buses if applicable and trips/activities

• Risk assessments for all aspects of work carried out by the Club, including

lone-working Risk Assessment Form, attached as document Appendix 1

• Events/Activities Safety Certificate Assessment, is attached as document

Appendix 2

• Membership/user group Application Forms Attached as document Appendix 3

& 4

• Guidelines for use of Consent Forms Attached as document Appendix 5, 5a

and 5b.

Whilst the club will do all that is within its powers to ensure the health and safety of

staff/volunteers and management committee, it is recognised that health and safety

at work is the responsibility of each and every individual. It is the duty of every

worker to take reasonable care of their own and other people’s welfare and to report

any situation, which may pose a threat to the wellbeing of any other person, provided

that such persons take reasonable care of their own welfare.

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The Club’s Health, Safety & Welfare Policy will be continually monitored and

updated, particularly when changes in the scale and nature of our operations occur.

The policy will be reviewed at least every 12 months.

The specific arrangements for the implementation of the Policy and the

personnel responsible are detailed below:

1. Safety Personnel

The current appointed Health and Safety Officer is:

Phil Symons and he has overall and final responsibility for health and safety within

the Club. The appointed Health and Safety person is also responsible for overseeing

and monitoring the Policy.

2. User Groups

All user groups hiring Killingworth Young Peoples Club will be asked to sign a

Service Level Agreement SLA Attached as document Appendix 4

Confirming that:

• All damage to premises/equipment during rental/accommodation period will

be charged for and must be reported to a senior worker and/or the

Management Committee immediately.

• All groups should ensure Health & Safety of their users and should have an

Emergency First Aid Kit, dedicated trained Health and Safety, First Aider and

Child Protection person/s.

• Accidents should be recorded in the accident book, obtainable from the Club.

• All groups should have Public Liability, Policies & Procedures and Enhanced

Criminal Record Bureau Checks CRB where applicable in place.

• The Club cannot be held responsible for any accident/loss or damage

incurred by user groups without insurance cover.

3. Communication

Communication between staff/volunteers, management committee and users at all

levels is an essential part of effective health and safety procedures. The dedicated

person for Health & Safety and the Management Committee will endeavour to

communicate their commitment to safety to ensure that staff/volunteers and user

groups are familiar with the contents of the Clubs Health, Safety and Welfare Policy.

4. Co-Operation & Care

Co-operation between staff/volunteers, management Committee and user groups at

all levels is essential. All workers have a duty to take reasonable steps to preserve

and protect the health and safety of themselves and all other people affected by the

operations of the Club.

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5. Staffing

The following good practice will help ensure everyone’s interests are protected and

that young people enjoy planned activities in a safe environment:

It is highly recommended to have a suitable ratio of responsible adult supervisors to

young people.

All activities must be risk assessed by a member of the committee to determine the

appropriate safe supervision level for that particular group/activity. For higher risk

activities, consideration will need to be given to there being greater adult supervision,

as appropriate. Young people must always be adequately supervised at all times

whilst participating in activities, even whilst accompanied by other adults.

Lone working must be avoided or practical measures taken to minimise risk.

Staff/volunteers should ensure that colleagues are aware of their locations at all

times. There should be a minimum of two “responsible Persons (adults) present at

every session, event or activity.

Suggested desirable ratios of adults: young people activities:

Young People aged 5-9 years = 1:6

Young People over the age of 9 years = 1:8

6. Training

Training is regarded as an indispensable ingredient of an effective health and safety

programme. It is highly recommended that all staff/volunteers and management

committee in the Club will be trained to perform his or her role effectively and safely.

All staff/volunteers and management committee will complete an induction in safe

working practices and procedures prior to be allocated any new role.

Information sharing sessions will be held as often as is deemed necessary and will

provide another opportunity for workers to express any fears or concerns they might

have about their duties.

The dedicated person for Health and Safety holds overall responsibility for co-

ordinating training; however it is also the responsibility of each individual to

recognise their own training needs.

7. Workplace Inspections

The designated person for Health and Safety and the Club Chairperson will conduct

regular inspections of the work place.

8. Working Environment

Staff/volunteers, management committee and user groups should ensure that:

• Work areas should be kept clean and tidy.

• Any spillage should be cleaned up immediately and cleaning articles and

substances are cleaned to designated locations after use.

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• Floor areas, should be cleaned on a regular basis and should be well lit and

free of obstruction.

• Waste materials and rubbish, should be removed routinely. All combustible

waste materials must be discarded in an approved manner.

• Any change in floor elevation of any walkway or passageway should be

clearly marked.

• Walkways and passageways should be kept clear from obstruction, however,

if objects are to be stored in or around a passageway for a short length of

time, care must be taken to ensure that no long or sharp edges jut out into the

passageway in such a way to constitute a safety hazard

9. Manual Handling

• Staff/volunteers, the management committee and users should not attempt to

lift or move a load that is too heavy to manage comfortably.

• Where team lifting or moving is necessary, one person should act as co-

ordinator, giving commands to lift, lower etc.

• When lifting an object off the floor workers should assume a squatting

position, keeping the back straight. The load should be lifted by straightening

the knees, do not bend the back. These steps should be reversed when

lowering an object to the floor.

10. Display Screen Equipment

It is the policy of Killingworth Young Peoples Club to comply with the law as set out

in the Health and Safety (Display Screen Equipment) Regulations 1992.

It is advisable that all Visual Display Units (VDU) should be fitted with anti-glare

screens.

It is good practice to monitor computer use and have a computer logbook in a

prominent area for users to complete.

11. Equipment Maintenance

Killingworth Young Peoples Club football pitch maintenance equipment is only to be

used by qualified and authorised personnel. It is the responsibility of the dedicated

Health and Safety Person to determine who is authorised to use specific tools and

equipment.

It is the responsibility of all workers to report to the dedicated Health and Safety

Person any defective tools or equipment and the responsibility of the dedicated

Health and Safety Person to ensure that these are repaired or replaced.

All tools are safely stored away when not in use.

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12. Control of Hazardous Substances

It is the policy of Killingworth Young Peoples Club to comply with the law set out in

the Control of Substances Hazardous to Health (COSHH) Regulations 1999.

All paint, cleaning equipment and petrol/diesel should be stored together in a secure

place, kept away from any heat source and access restricted.

A COSHH risk assessment will be conducted on all work involving exposure to

hazardous substances. The assessment will be based on the manufacturers, and

suppliers’ health and safety guidance and our own knowledge of the work process.

Exposure to hazardous substances is minimised and adequately controlled in all

cases.

Anyone who comes in to contact with hazardous substances will receive

comprehensive, adequate training and information on the health & safety issues

relating to that type of work.

13. Smoking Policy

The Smoke free Law introduced in 2007; it is aimed to protect the public from the

harmful effects of second-hand smoke, ensuring that all public places and

workplaces are smoke free. The law requires no-smoking signs to be displayed in

all smoke free premises. The management committee have legal responsibilities to

ensure everyone adheres to this and failure to comply will be a criminal offence.

Penalties and fines for smoke free offences are as follows:

• Smoking in smoke free premises: a fixed penalty notice of £50 imposed on

the person smoking. Or a maximum fine of £200 if prosecuted and convicted

in court.

• Failure to display no-smoking signs: a fixed penalty notice of £200

imposed on whoever manages or occupies the smoke free premises. Or a

maximum fine of £1000 if prosecuted and convicted by a court.

• Failing to prevent smoking in a smoke free place: a maximum fine of

£2500 imposed on whoever manages or controls the smoke free premises if

prosecuted and convicted by a court.

14. Fire Safety Guidelines

14.1 Fire Safety

The Clubs Fire Safety Guidelines take account of special fire hazards in specific

areas of the premises and where appropriate, have been compiled with the

assistance of the local fire service, who assist with inspecting and testing firefighting

prevention and protection equipment, as well as advising on safe practices and

procedures.

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Under the Regulatory Reform (Fire Safety) Order 2005 the responsible person for

each premises is required to carry out a Fire Safety Risk Assessment (FRA) and

take steps to reduce or remove any risks. The FRA will take into consideration the

effect a fire may have on anyone in or around the immediate vicinity. This will be

kept under regular review; a management plan should be implemented and

maintained.

Fire Safety Law changed in October 2006 with the introduction of the Regulatory

Reform (Fire Safety) Order 2005. The requirement for premises to have fire

certificates has been abolished and any previously held are no longer valid.

Instead the law:

• Emphasises preventing fires and reducing risk

• Places the responsibility on the Club to ensure the safety of everyone who

uses the Clubs premises.

The dedicated person for Health and Safety is responsible for:

• The regular provision, maintenance and implementation of fire prevention i.e.

(testing of fire/smoke alarms), detection and firefighting equipment.

• Ensuring Fire Safety and Fire Exits signs are clearly displayed at the strategic

points throughout the Club.

• Keeping and operating areas safe from fire, ensuring that management

committee and user groups are aware of this policy and are trained in fire

prevention practices and emergency procedures.

• Ensuring the safety of everyone who uses the premises and the immediate

vicinity.

All staff, management committee and user groups should:

• Be aware of, respect and adhere to the procedures contained in this policy.

• Ensure all areas, emergency routes and exits are maintained and kept clear

at all times.

• Have a duty to immediately report any fire, smoke or potential fire hazards to

the fire service (dial 999).

• Have a responsibility to conduct their operations in such a way to minimise

the risk of fire. This involves adhering to the smoking policy, keeping

combustible materials separate from sources of ignition and avoiding

unnecessary accumulation of combustible materials.

• Know the evacuation route and assembly point in case of fire. The name of

the dedicated Health and Safety person and evacuation details should be

displayed in a prominent place.

• Risk assessments will be conducted prior to every session/activity in

connection with health and safety associated with the Club.

14.2 Fire Detection Equipment

Fire/smoke alarms are located at strategic points throughout the Club and are

frequently maintained and tested by the appointed Health & Safety person.

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14.3 Fire Fighting Equipment

Fire extinguishers and fire blankets are located at strategic points throughout the

Club. Staff, management committee and user groups are not expected to tackle a

fire themselves unless trained to use the fire extinguishers. If the situation is

dangerous or potentially dangerous, the fire alarm must be activated and the building

evacuated.

14.4 Fire Exits

Are clearly marked and must be kept clear from obstruction in case of an emergency

evacuation.

14.5 Emergency Evacuation Procedure

In the event of a fire alarm being activated, everyone must leave the building by the

nearest available exit and assemble at the designated assembly point. Practice fire

drills will be conducted more frequently to ensure familiarity with the emergency

evacuation procedure.

14.6 Fire and Emergency Procedures.

The appointed Health & Safety person is responsible for ensuring all staff,

management committee and user groups are aware of the Clubs Fire and

Emergency Procedures. Information about fire precautions will be given at suitable

and regular periods.

Accordingly, as soon as possible new staff and user groups should be conducted

over the whole of the premises and should be shown and instructed in basic fire

precaution measures e.g.

• Run through the fire procedure notice with them

• Location of the fire alarm points and how to operate them

• Location of fire extinguishers

• What to do on discovery of a fire

• Means of escape routes

• Fire exits

• Location of Assembly Point

• Run through Roll Call procedures

The Club is responsible for maintaining a current up-to-date daily register of persons

on the premises. The senior staff member shall take a roll call should the fire alarm

operate, reporting the outcome to the appointed Health & Safety person.

All staff, management committee and user groups must ensure safe exit from the

building of any users/visitors being entertained at the time of the fire alarm sounding

and should check that the designated areas are evacuated of all persons.

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15. Accidents/First Aid

15.1 Accident investigation & Reporting

It is the Club policy to comply with the Reporting of Injuries, Diseases and

Dangerous Occurrences Regulations 1995 (RIDDOR95).

15.2 Reporting Accidents/Incidents

In the case of an accident causing injury the Club must ensure the injured person is

being cared for and send immediately for a First Aider. Do Not move the injured

person. In the case of an emergency dial 999 and ask for the Ambulance Service.

15.3 Accident Book/Reporting

The Club has an Accident Report Book. A log of every accident, injury or incident

must be made and kept on file in accordance with Data Protection.

Staff, management committee and user groups responsibilities:

If injured at work the law says you have to report this to your employer. We adopt the

same procedures at KYPC if a person is injured at the Club.

Accident investigation is a valuable tool in the prevention of future incidents. In the

event of an accident resulting in injury the appointed Health & Safety person will

draw up a report detailing:

• The circumstances of the accident

• The nature and severity of the injury sustained

• Identity of any eye witnesses

• Time, date and location of the incident

• Date of the report

All eyewitnesses accounts will be collected as near to the time of the incident as is

reasonably practicable.

The completed report will then be analysed by the appointed Health & Safety person

who will attempt to discover why the accident occurred and what actions, if any,

should be taken to prevent a reoccurrence.

A follow up report will be completed after a reasonable period of time examining the

effectiveness of the new measures adopted.

15.4 First Aid

It is the attention of KYPC to comply with the Health and Safety (First Aid)

Regulations 1981 and the Approved Code of Practice (First Aid) regulations (COP

42).

• First Aid boxes should be kept in the Club; one appointed trained person is

responsible for the regular checking and restoring of the First Aid Equipment

and should take control when someone is injured or ill and call emergency

services if necessary.

• First Aid Station must be clearly marked, maintained and be easily accessible.

• Ensure a working telephone is always available

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The Current Appointed First Aid Person is:

John Celino he is responsible for reporting all cases of accidents and illnesses to

the appointed Health & Safety person who records and maintains all accident

information. All staff and user groups are responsible for reporting cases of accidents

& illness to the appointed Health & Safety person.

16. All staff, management committee and user groups:

Should

• Be aware of, respect and adhere to the rules and procedures contained in

this policy statement.

• Have a duty to take reasonable steps to preserve and protect the health and

safety of themselves and all other people affected by the operations of the

Club.

• Immediately report any unsafe practices or conditions to the relevant

authority

• Carry out necessary risk assessments and keep and maintain accurate

records of accidents, injuries, dangerous occurrences and known exposure to

health risks.

Should not

• Take any prescribed medication that may impair judgement. Any person

should stay away from the Club whilst taking such medication.

• Be suspected of being under the influence of alcohol or any illicit, illegal or

intoxicating substances.

• Smoke within the premises.

• Undertake a task which appears unsafe without a review of the risk, until

adequate safety instructions have been received and they are authorised to

do so.

17. Centre based work with young people

As an organisation working with young people the Club’s management committee

recognise their duty of care.

• Applications for membership from young people to join the Club will be carried

out annually.

• All indoor/outdoor sessions, activities, trips and events involving young people

are planned and prepared in advance and have been done in line with risk

assessments and wherever possible, measures are made to reduce risks and

potential harm.

• Clear ground rules are established and agreed with all young people.

• Offsite Trips/Activities: Involving young people are all carried out with a full

risk assessment and only once insurance, consent and safety certificates are

in place and issued.

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18.Commitment to Practice

This policy was adopted by the Management Committee on ……………………………

This policy will be reviewed by the Management Committee on ………………………..

Signed Name Chairperson

Signed Name Appointed H&S person

Signed Name Appointed First Aider

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Killingworth Young Peoples Club

Appendix 1 Risk Assessment Sheet

Club Name: --------------------------------------------------

Session/Project/Activity or Event: -----------------------------------------------

Date: -----------------------------------------------------------

Organiser: -----------------------------------------------------

Prior to any session/activity with young people it is essential that a full risk assessment is carried out taking into account their age

and inexperience. Measures are taken to identify any potential hazards (things that cause harm) and risks (the harm that could be

caused).

It is important that using the 1-5 scale will make a decision on the level of risk attached to a particular hazard.

Likelihood of Hazard Taking Place Severity of harm should hazard take place

1 2 3 4 5 2 3 4 5 6 3 4 5 6 7 4 5 6 7 8 5 6 7 8 9

Note Example: If you grade the likelihood of the hazard occurring as a 3 (in the horizontal) and the severity as a 4 (vertical) the overall risk would be 6. Making it a medium Risk based on the below figures.

1-2 Low Risk 3-6 Medium Risk 8-9 High Risk

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Appendix 1 Killingworth Young Peoples Club

Health, Safety & Welfare Policy

With this in mind it is imperative that we identify ways of reducing both the likelihood and severity of harm taking place.

Hazard (what could go wrong)

Risk (What harm would it cause)

Who is at Risk Risk level (low, medium, high)

Risk Reduction Plan

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Appendix 1 Health, Safety & Welfare Policy

The Person in charge of each session is required to complete a Safety Certificate.

When an item is initialled by the Person in charge it will be assumed that the

associated statement is correct.

Person in Charge ---------------------------------------------

Staff & Volunteers ---------------------------------------------

---------------------------------------------

---------------------------------------------

All staff are either qualified or competent to manage the activity assigned.

Activity: ---------------------------------------------------------------------

Date: --------------------------------------------------------------------------

Venue: ------------------------------------------------------------------------

Contact Telephone Number: ------------------------------------------

Inspection

Date of inspection

The venue is easily and safely accessible – to all participants ----------------------

Sufficient fire extinguishers are available, and regularly tested ----------------------

The means of communication with the emergency services is

easily accessible. ----------------------

The location of the nearest hospital and/or doctor displayed ----------------------

Fire Blankets & First Aid Stations are clearly identified and

easily accessible. ----------------------

Emergency exits are clear and easily accessible ----------------------

Sufficient lavatory, washing and changing facilities are available

for both genders ----------------------

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Participants

Number -------------------------------------------------------------------

Age Range ---------------------------------------------------------------

Participants with specific needs -------------------------------------

How these needs are addressed ------------------------------------

All participants aged under 16 are participating with parental

consent -----------

First Aid

Appointed First Aider -----------------------------

Transport

All vehicles used in connection with the organisation of the event are:

• Insured -----------------

• Fitted with seat belts -----------------

• Fitted with First Aid Kits -----------------

• Have forward facing seats -----------------

• All drivers are licensed and registered -----------------

Insurance

The activity is insured---------------------------------------------------

Participants are covered for personal liability and injury ------------------

Programme

The programme is participative and appropriate to the age range and

gender(s) ----------------------------

Risk Assessment

A Risk Assessment for the event at its venue has been made and appropriate action taken

to minimise risk to participants. A copy of the completed Risk Assessment is attached.

Details of any special provision made:

----------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------

Signed -------------------------------------------

Date --------------------------------------------

This completed form must be handed to the Club Secretary at least one week prior to the

day of the event

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Appendix 3 Application for Membership

Please complete all sections of this form

Section One – About the person joining the Club

Surname ------------------------------- Date of Birth -----/-----/-----

Forenames ---------------------------- School ------------------------

Address: -----------------------------------------------------------------------

Section Two – Parent/Care, Emergency Contacts & Medical Consent

Name of young person joining the Club --------------------------------------------

Name (Parent/Carer) ---------------------------------------------

Signed ---------------------------------------------

Address: ---------------------------------------------

---------------------------------------------

---------------------------------------------

Post Code ---------------------------------------------

Telephone Number ---------------------------- Mobile ---------------------------------

In case of emergency, please give alternative contact.

Name --------------------------------------------- Number -------------------------------

Section Three – Medical Details

If you answer yes to any of the questions below, please give brief details:

Are you requiring regular treatment? ---------------------------------------

Have you any special dietary requirements? ---------------------------------------

Have any known allergies? ---------------------------------------

Are you Asthmatic? ---------------------------------------

Are you sensitive to penicillin? ---------------------------------------

Have you ever had a serious illness/ ---------------------------------------

Any other medical information? ---------------------------------------

Name of doctor: ---------------------------------------

Address: --------------------------------------------------------------------

---------------------------------------------------------------------

---------------------------------------------------------------------

Telephone Number -------------------------------- Post Code ------------------------

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Appendix 3 Application for Membership

Section Four – Photography/Video Recording Etc.

We may take photos and use recording devices for displays and publicity. These may

be passed on to different organisations and partnerships during joint events etc.

Please sign below to give your consent for photography and recording of your

child/young person.

I agree for my child to be in photo and recording material to be used for displays and

publicity reasons only. I also agree for photos and recording material to be shared with other

organisations and partnerships for publicity and promotional use only.

Signed Parent/Carer --------------------------------------------------------

Date --------------------------------------------------------

Section Five – Any Additional Information?

If any of the above information changes please ensure you inform the Club as soon as

possible.

Please Note: children/young people attending the Club should agree to the ground rules set

out by the Club.

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KILLINGWORTH YOUNG PEOPLES CLUB

Address: Amberley Park, Garth 21, Killingworth, NE12 6SD

--------------------------------------------------------------------------------------------------------------

User Group Consent Form

Name of Group/Organisation ------------------------------------------------

Contact Name ------------------------------------------------

Position in Group/Organisation ------------------------------------------------

Address ------------------------------------------------------------------------------------------

Telephone Number --------------------------- Mobile ---------------------------------------

Purpose of Booking ----------------------------------------------------------

Room Requirements ----------------------------------------------------------

Equipment Required ----------------------------------------------------------

Date(s) Required ----------------------------------------------------------

Start Time -------------------------- Finish Time -------------------------------

Conditions of Hire

1. Form to be completed and rental fee paid at least 7 days prior to date booked

2. Long term rental to be paid monthly in advance, at least 7 days prior to 1st

date

3. At least 3 days’ notice required for cancellation, otherwise full rental will be

retained

4. All damage to premises/equipment (during rental/accommodation period) will

be charged for and must be reported to the Club Secretary immediately.

5. All groups should ensure Health & Safety of their users and have an

Emergency First Aid Kit, dedicated trained First Aider and Safeguarding

Person(s).

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6. Accidents must be reported to the appointed Health & Safety Person and

recorded in the accident book.

7. All groups should have Public Liability Insurance, Policies and Procedures

and Disclosure and barring Service (DBS) in place.

8. All Groups must adhere to KYPC Policies & Procedures (a copy can be

requested from the Club Secretary).

9. KYPC cannot be held responsible for accident/loss or damage incurred by

user groups without insurance cover.

I, undersigned, on behalf of the above group/organisation agree to the conditions of

hire.

Please print name ------------------------------------------------

Signature ------------------------------------------------

Date -------------------------------------------------

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Consent Form Guidelines Consent forms should be given out for young people under 16 years in the following

circumstances:

1. Trip/activity

2. Trip/activity where contact with water in rivers, ponds or canals is planned.

There are different consent forms for each activity listed above.

Until a person is 16 years of age, the responsible adult in their life is legally

responsible for them, whether parent or guardian.

As Club members steps should be taken to ensure that those adults have the

opportunity to be involved in decisions affecting the young person to take part in

activities that may involve greater risk taking.

Consent forms should always be handed out well in advance of sessions and

returned before the activity takes place.

When the Club gives their telephone contact number, they should ensure that it is a

number where they can be easily contacted. This may be a particular time in a

building where they visit.

Always ensure that the session is planned to take account of the young peoples

differing needs. This might include young people with learning difficulties, or those

with hearing or visual impairments.

Although you will be aware of some of the differing needs of your groups, it is worth

checking out their individual needs in a sensitive manner.

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Appendix 5a Health, Safety & Welfare Policy

Trip/Activity – Consent Form 1

The --------------------------------------------------- group will be taking part in:-

Activity ----------------------------------------------- Date --------------------------

Cost ----------------------

Venue ------------------------------------------------------------------------------------

We will be leaving at ------------------------------ Returning at ------------------

Transport will/will not be made available

Please ask your parent or responsible adult to sign the following form, which will give

consent for you to take part in the above activity. If you require further information

about the activities, please contact the Club.

1. ------------------------------------------------ Contact no. --------------------------

2. ------------------------------------------------ Contact no ---------------------------

Name of Daughter/Son -----------------------------------------------------------------

Date of Birth --------------------------------------------------

Contact Name ------------------------------------------------

Address --------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------

Telephone Number -----------------------------------------

Name of Doctor ------------------------------------- Telephone no --------------------------------

Medical Condition/Any medication you use/special needs ------------------------------------

----------------------------------------------------------------------------------------------------------------

Dietary Requirements ----------------------------------------------------------------------------------

In the event of your daughter/son needing medical attention, your signature will give

us consent to seek it. The leader of the group cannot take responsibility for damage,

loss or injury to members, person or property while with the group.

Parent/Responsible Adult Signature ------------------------------------------------------

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Appendix 5b Health, Safety & Welfare Policy

Trip/Activity2 – Consent Form

Trip/activity where contact with water in rivers, ponds or canals is planned.

The --------------------------------------------------- group will be taking part in:-

Activity ----------------------------------------------- Date --------------------------

Cost ----------------------

Venue ------------------------------------------------------------------------------------

We will be leaving at ------------------------------ Returning at ------------------

Transport will/will not be made available

Please ask your parent or responsible adult to sign the following form, which will give

consent for you to take part in the above activity. If you require further information

about the activities, please contact the Club.

1. ------------------------------------------------ Contact no. --------------------------

2. ------------------------------------------------ Contact no ---------------------------

Name of Daughter/Son -----------------------------------------------------------------

Date of Birth --------------------------------------------------

Contact Name ------------------------------------------------

Address --------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------

Telephone Number -----------------------------------------

Name of Doctor ------------------------------------- Telephone no --------------------------------

Medical Condition/Any medication you use/special needs ------------------------------------

----------------------------------------------------------------------------------------------------------------

Dietary Requirements ----------------------------------------------------------------------------------

In the event of your daughter/son needing medical attention, your signature will give

us consent to seek it. The leader of the group cannot take responsibility for damage,

loss or injury to members, person or property while with the group.

Parent/Responsible Adult Signature ------------------------------------------------------

killingworth young peoples club

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