Health and safety policy statement

Develop your health and safety policy statement with our template which can exported as an editable PDF. It may not be entirely suitable for your needs and so, if this is the case, you should just use it as a starting point to develop your own.

We've inserted tooltips in this webpage (which appear when you click on a field that has one) to help you complete this form; These tooltips won't appear in the PDF you export.

Please note that fields marked with asterisk (*) are mandatory.

  • 1 Statement
  • 2 Roles and responsibilities
  • 3 Arrangements
  • 4 Training, accidents and monitoring
  • 5 Emergency procedures

Our statement of general policy is:

  • to provide adequate control of the health and safety risks arising from our work activities, to our own employees and also to others who may be affected by them;
  • to consult with our employees on matters affecting their health and safety;
  • to provide and maintain safe plant and equipment;
  • to ensure the safe handling and use of substances;
  • to provide information, instruction and supervision for employees;
  • to ensure all employees are competent to do their tasks, and to give them adequate training;
  • to prevent accidents and cases of work-related ill-health;
  • to maintain safe and healthy working conditions;
  • to make available adequate resources for managing and controlling health and safety; and
  • to review and revise this policy, as necessary, at regular intervals.
Responsible person(s)
field description
Who should be the responsible person? This form should be completed by the employer (i.e. sole trader, senior partner or managing director). You, the employer, have overall responsibility for health and safety.
field description
Delegating responsibility If you're not always there, or do not have time to manage on a day-to-day basis, you can delegate this role to someone else, e.g. director, manager or supervisor. You need to ensure that they keep you fully informed of health and safety matters – it will still be your overall responsibility.

The responsibility to maintain and improve health and safety standards is held by the following people in the following areas:

Responsible person
field description
Responsible person(s) You may delegate functions to people within your organisation, either by specific areas within the workplace or by topic. Include their specific responsibilities in their job description (if they have one) and ensure they're competent and have adequate resources to fulfil their role properly. It may be a good idea to insert a diagram or chart showing your management structure and arrangements.

All employees need to:

  • co-operate with supervisors and managers on health and safety matters;
  • not interfere with anything provided to safeguard their health and safety;
  • take reasonable care of their own health and safety; and
  • report all health and safety concerns to an appropriate person (as detailed in this policy statement).
Competent person
Consultation with employees
Employee representative
field description
H&S committees If you have a health and safety committee, you should list what it does, who is on it and how often it meets.
Safe handling and use of substances
Safe plant and equipment
Information, instruction and supervision
Competency for tasks and training
Job requiring special training
Accidents, first aid and work related ill health
First aider
Emergency procedures – fire and evacuation
  • 1 Statement
  • 2 Roles and responsibilities
  • 3 Arrangements
  • 4 Training, accidents and monitoring
  • 5 Emergency procedures

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