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4.4 Legal Appointments

The document outlines the legal appointments and responsibilities of employees, the chief executive officer, and the assistant chief executive officer under the Occupational Health and Safety Act 85 of 1993. It provides templates for appointing a project manager, assistant chief executive officer, or other positions. The templates require listing the duties and responsibilities of the appointee, and signatures from the authorized designator and appointee to acknowledge the appointment and its requirements. The templates can also be used to terminate an appointment.

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4.4 Legal Appointments

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Legal Appointments

Document Number: HSF-04.5

Legal Appointments
Employee
Occupational Health and Safety Act 85 of 1993 Section 14
Every employee shall at work—
(a) take reasonable care for the health and safety of himself and of other persons who may be affected by his acts or
omissions;
(b) as regards any duty or requirement imposed on his employer or any other person by this Act, co-operate with
such employer or person to enable that duty or requirement to be performed or complied with;
(c) carry out any lawful order given to him, and obey the health and safety rules and procedures laid down by his
employer or by anyone authorized thereto by his employer, in the interest of health or safety;
(d) if any situation which is unsafe or unhealthy comes to his attention, as soon as practicable report such situation to
his employer or to the health and safety representative for his workplace or section thereof, as the case may be,
who shall report it to the employer; and
(e) if he is involved in any incident which may affect his health or which has caused an injury to himself, report such
incident to his employer or to anyone authorized thereto by the employer, or to his health and safety
representative, as soon as practicable but not later than the end of the particular shift during which the incident
occurred, unless the circumstances were such that the reporting of the incident was not possible, in which case
he shall report the incident as soon as practicable thereafter.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
(Please List Duties and Responsibilities here)
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................
Acceptance
I, .................................................... hereby acknowledge receipt of and accept and understand the requirements
of this designation.
Signature Designation Date

....../........../20......
.....................................................
Cancellation/Termination of Legal Appointment
I, ....................................................... the ................................................ for, .......................................... do hereby
terminate and relieve, ................................................ as a, ............................................... for his/her duties and
responsibilities as stipulated by this legal appointment from ....../........../20......
Signature Designation Date

....../........../20......
.....................................................

Page 1 of 33
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Legal Appointments
Document Number: HSF-04.5

Assistant Chief Executive Officer

Occupational Health and Safety Act 85 of 1993 Section 16(2)
(1) Every chief executive officer shall as far as is reasonably practicable ensure that the duties of his employer as
contemplated in this Act, are properly discharged.
(2) Without derogating from his responsibility or liability in terms of subsection (1), a chief executive officer may
assign any duty contemplated in the said subsection, to any person under his control, which person shall act
subject to the control and directions of the chief executive officer.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
(Please List Duties and Responsibilities here)
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 2 of 33
UNCONTROLLED Classification: Proprietary Author: JMZ de Wet
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Legal Appointments
Document Number: HSF-04.5

Project Manager
Occupational Health and Safety Act 85 of 1993 Section 16(2)
(1) Every chief executive officer shall as far as is reasonably practicable ensure that the duties of his employer as
contemplated in this Act, are properly discharged.
(2) Without derogating from his responsibility or liability in terms of subsection (1), a chief executive officer may
assign any duty contemplated in the said subsection, to any person under his control, which person shall act
subject to the control and directions of the chief executive officer.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- All work is performed by suitably trained and competent persons;
- All statutory appointments have been completed and all statutory requirements are met;
- Where required, health and safety committees are established, that meetings are accordingly held and
that the minutes of such meetings are kept and properly filed;
- All persons are aware of the hazards attached to the work being carried out and are fully conversant
with the precautionary measures to be taken or observed to obviate such dangers;
- The required risk assessments are carried out;
- Discipline is enforced at the construction site at all times;
- Any other requirements, in terms of health and safety with respect to the responsible area, are met;
and
- Any advice and assistance from an appointed safety officer is considered when you make decisions that
may impact the health and safety of any person on the site.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Legal Appointments
Document Number: HSF-04.5

Health and Safety Representative

Occupational Health and Safety Act 85 of 1993 Section 17(1)
(1) Subject to the provisions of subsection (2), every employer who has more than 20 employees in his employment
at any work-place, shall, within four months after the commencement of this Act or after commencing business,
or from such time as the number of employees exceeds 20, as the case may be, designate in writing for a
specified period health and safety representatives for such work-place, or for different sections thereof.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- To represent your employee electorate’s interests in terms of occupational health and safety;
- To carry out health and safety inspections of your workplace, as designated above, prior to health and
safety committee meetings;
- To serve on the appropriate health and safety committee;
- To bring to the attention of your supervisor any deviations of health and safety issues that come to
your attention;
- To investigate, or assist with the investigation, of incidents in your area of responsibility.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 4 of 33
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Legal Appointments
Document Number: HSF-04.5

Health and Safety Committee Member

Occupational Health and Safety Act 85 of 1993 Section 19(3)
(3) The persons nominated by an employer on a health and safety committee shall be designated in writing by the
employer for such period as may be determined by him, while the health and safety representatives shall be
members of the committee for the period of their designation in terms of section 17 (1).
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- To represent the employer’s interests in terms of occupational health and safety;
- To serve on the appropriate health and safety committee;
- To bring to the attention of your supervisor any deviations of health and safety issues that come to
your attention;
- To perform any further functions that may be required by the employer in the interest of health and
safety.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Legal Appointments
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Health and Safety Committee Chairperson

Legal Reference
(3) The persons nominated by an employer on a health and safety committee shall be designated in writing by the
employer for such period as may be determined by him, while the health and safety representatives shall be
members of the committee for the period of their designation in terms of section 17 (1).
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- To ensure that the elected health and safety committee meets at intervals not exceeding once (a
week/every two weeks/a month/every two months/a quarter) to discuss health and safety matters;
- To ensure, in particular, that all recordable incidents are fully discussed and that the committee decides
on measures to be implemented to prevent a re-occurrence of such an incident – (Annexure 1) must be
signed by you, as the chairperson of the committee;
- To ensure, furthermore, that minutes are kept of all health and safety committee meetings and that
such minutes are forwarded to the management representative not later than a week after the date of
the meeting; and
- To ensure that the date and time of the following health and safety committee meeting be decided by
the committee and be reflected in the minutes of the meeting.
- You should familiarise yourself with the provisions of the Act and its Regulations that relate to the
functions of the health and safety committee, to enable you to effectively and efficiently carry out your
functions as stipulated.
- You will be required to undergo Health and Safety training in order to ensure that you can complete
your tasks successfully.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 6 of 33
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Legal Appointments
Document Number: HSF-04.5

Assistant Construction Manager

Construction Regulations 2014 Regulation 8(2)
(2) A principal contractor must upon having considered the size of the project, in writing appoint one or more
assistant construction managers for different sections thereof: Provided that the designation of any such person
does not relieve the construction manager of any personal accountability for failing in his or her management
duties in terms of this regulation.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- That all work is performed by suitably trained and competent persons;
- That all statutory appointments have been completed and all statutory requirements are met;
- That, where required, health and safety committees are established, that meetings are accordingly held
and that the minutes of such meetings are kept and properly filed;
- That all persons are aware of the hazards attached to the work being carried out and are fully
conversant with the precautionary measures to be taken or observed to obviate such dangers;
- That the required risk assessments are carried out;
- That discipline is enforced at the construction site at all times;
- That any other requirements, in terms of health and safety with respect to the responsible area, are
me; and
- That any advice or assistance from an appointed safety officer is considered when you make decisions
that may impact the health and safety of any person on the site.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 7 of 33
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Legal Appointments
Document Number: HSF-04.5

Assistant Construction Supervisor

Construction Regulations 2014 Regulation 8(8)
(8) A contractor must, upon having considered the size of the project, in writing appoint one or more competent
employees for different sections thereof to assist the construction supervisor contemplated in sub regulation (7),
and every such employee has, to the extent clearly defined by the contractor in the letter of appointment, the
same duties is the construction supervisor: Provided that the designation of any such employee does not relieve
the construction supervisor of any personal accountability for failing in his or her supervisory duties in terms of
this regulation.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- That the work area has been assessed for health and safety hazards and that all identified workplace
risks are controlled;
- That all work is performed only by suitably trained and competent persons who know and understand
the scope of their authority;
- That all equipment used for the task is safe and maintained to the manufacturer’s specifications;
- That the health and safety hazards of any materials used is known and that appropriate HSE controls
have been implemented;
- That all persons are aware of the hazards and risks attached to the work being carried out and are fully
conversant with the precautionary measures to be taken or observed to control such dangers by
sharing Daily Safe Task Instructions with them before any new task is started;
- That discipline is enforced on the tasks under your supervision at all times;
- That the required Planned Job Observations are carried out; and
- That all the prescribed HSE control forms are completed to ensure the above-mentioned steps.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Assistant Supervisor of Machinery

General Machinery Regulations Regulation 2(7)
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(7) (a) An employer or user of machinery may designate one or more competent persons to assist a person
designated in terms of sub regulation (1).
(b) The chief inspector may by written notice direct any employer or user of machinery to designate within the
period specified in the notice the number of persons so specified holding the qualifications so specified to assist a
person designated in terms of sub regulation (1).
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- That all machinery is suitable for the purpose for which it is used;
- That it is installed, operated and maintained (including any safety equipment) in such a manner as to
prevent the exposure of persons to hazardous conditions or circumstances;
- That all exposed and dangerous parts of machines, within normal reach of persons, be effectively
safeguarded;
- That machines are only operated by persons who have been authorised and who are fully aware of the
dangers attached thereto and are conversant with the precautionary measures to be taken or observed
to obviate such dangers;
- That effective precautionary measures are developed and implemented to protect persons whilst
performing maintenance, cleaning or adjustment work;
- That any prescribed statutory inspections and/or tests be performed by a competent person and that
the records in this regard are kept and maintained; and
- That any machine which threatens the safety of any person be stopped immediately.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 9 of 33
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Approved by: XXX Approval Date: 30/01/2020 Revision number: 2020-00
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Legal Appointments
Document Number: HSF-04.5

Client Agent
Construction Regulations 2014 Regulation 5(5)
- Where a construction work permit is required as contemplated in regulation 3(1), the client must, without
derogating from his or her health and safety responsibilities or liabilities, appoint a competent person in writing
as an agent to act as his or her representative, and where such an appointment is made the duties that are
imposed by these Regulations upon a client, apply as far as reasonably practicable to the agent so appointed.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- Prepare a documented health and safety plan based on the client’s requirements and provided
baseline risk assessment, negotiate such plan with the principal contractor, and after it has been
approved by the latter, ensure that it is implemented and maintained for the duration of construction
work;
- Ensure that all work is carried out by suitably trained/competent persons with the necessary resources
at their disposal to ensure that work is performed safely and without risk to health and that only
persons who have undergone effective induction training are allowed on site;
- Open a health and safety file in which all documents required in terms of the Act and the Construction
Regulations are filed and to make the file available for inspection for the entire duration of the
construction work;
- Co-operate with other contractors in order to ensure compliance with the provisions of the
Construction Regulations; and
- Appoint only competent subcontractors, and when doing so, define all the responsibilities of the
principal contractor as contemplated in the Construction Regulations, and contracted under section
37(2) of the Act, and continually assesses subcontractor compliance with these.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 10 of 33
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All printouts marked “UNCONTROLLED” are valid only for 3 days from this date - 08/05/2020
Legal Appointments
Document Number: HSF-04.5

Confined Space Inspector

General Safety Regulations, Regulation 5

Page 11 of 33
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(1) An employer or a user of machinery shall take steps to ensure that a confined space is entered by an employee or
other person only after the air therein has been tested and evaluated by a person who is competent to
pronounce on the safety thereof, and who has certified in writing that the confined space is safe and will remain
safe while any person is in the confined space, taking into account the nature and duration of the work to be
performed therein.
(2) Where the provisions of sub regulation (1) cannot be complied with the employer or user of machinery, as the
case may be, shall take steps to ensure that any confined space in which there exists or is likely to exist a
hazardous gas, vapour, dust or fumes, or which has or is likely to have, an oxygen content of less than 20 per cent
by volume, is entered by an employee or other person only when—
a. subject to the provisions of sub regulation (3), the confined space is purged and ventilated to provide a
safe atmosphere therein and measures necessary to maintain a safe atmosphere therein have been
taken; and
b. the confined space has been isolated from all pipes, ducts and other communicating openings by means
of effective blanking other than the shutting or locking of a valve or a cock, or, if this is not practicable,
only when all valves and cocks which are a potential source of danger have been locked and securely
fastened by means of chains and padlocks.
(3) Where the provisions of sub regulation (2)(a) cannot be complied with, the employer or user of machinery shall
take steps to ensure that the confined space in question is entered only when the employee or person entering is
using breathing apparatus of a type approved by the chief inspector and, further, that—
a. the provisions of sub regulation (2) (b) are complied with;
b. any employee or person entering the confined space is using a safety harness or other similar
equipment, to which a rope is securely attached which reaches beyond the access to the confined space,
and the free end of which is attended to by a person referred to in paragraph (c);
c. at least one other person trained in resuscitation is and remains in attendance immediately outside the
entrance of the confined space in order to assist or remove any or persons from the confined space, if
necessary; and
d. effective apparatus for breathing and resuscitation of a type approved by the chief inspector is available
immediately out side the confined space.
(4) An employer or user of machinery shall take steps to ensure that all persons vacate a confined space on
completion of any work therein.
(5) Where the hazardous gas, vapour, dust or fumes contemplated in sub regulation (2) are of an explosive or
flammable nature, an employer or user of machinery shall further take steps to ensure that such a confined space
is entered only if –
a. the concentration of the gas, vapour, dust or fumes does not exceed 25 per cent of the lower explosive
limit of the gas, vapour, dust or fumes concerned where the work to be performed is of such a nature
that it does not create a source of ignition; or
b. such concentration does not exceed 10 per cent of the lower explosive limit of the gas, vapour, dust or
fumes where other work is performed.
(6) The provisions of this regulation shall mutatis mutandis also apply, in so far as they can be so applied, to any work
which is performed in any place or space on the outside of and bordering on or in the immediate vicinity of, any
confined space, and in which place or space, owing to its proximity to the confined space, any hazardous article,
oxygen-deficient atmosphere or dangerous concentration of gas, vapour, dust or fumes may occur or be present

I, ....................................................... the ................................................ for, .......................................... do hereby

Duties and Responsibilities

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- Familiarise yourself with Regulation 5 of the General Safety Regulations and give full effect to same;
- Ensure that the employee, along with any other person entering a confined space, is using a safety
harness or similar equipment, to which a rope is securely attached and the free end of the rope is
attended by a person referred to in GSR 5(3)(c);
- Test and evaluate the air in confined spaces before the commencement of work; and
- Declare in writing that a confined space is safe and will remain safe while any person is working in that
space.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 13 of 33
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Legal Appointments
Document Number: HSF-04.5

Construction Manager
Construction Regulations 2014 Regulation 8(1)
(1) A principal contractor must in writing appoint one full-time competent person as the construction manager
with the duty of managing all the construction work on a single site, including the duty of ensuring
occupational health and safety compliance, and in the absence of the construction manager an alternate
must be appointed by the principal contractor.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- That all work is performed by suitably trained and competent persons;
- That all statutory appointments have been completed and all statutory requirements are met;
- That, where required, health and safety committees are established, that meetings are accordingly held
and that the minutes of such meetings are kept and properly filed;
- That all persons are aware of the hazards attached to the work being carried out and are fully
conversant with the precautionary measures to be taken or observed to obviate such dangers;
- That the required risk assessments are carried out;
- That discipline is enforced at the construction site at all times;
- That any other requirements, in terms of health and safety with respect to the responsible area are
met; and
- That any advice or assistance from an appointed safety officer is considered when you make decisions
that may impact the health and safety of any person on the site.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 14 of 33
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Approved by: XXX Approval Date: 30/01/2020 Revision number: 2020-00
All printouts marked “UNCONTROLLED” are valid only for 3 days from this date - 08/05/2020
Legal Appointments
Document Number: HSF-04.5

Construction Health and Safety Officer

Construction Regulations 2014 Regulation 8(5)
(5) A contractor must, after consultation with the client and having considered the size of the project, the degree of
danger likely to be encountered or the accumulation of hazards or risks on the site, appoint a full-time or part-time
construction health and safety officer in writing to assist in the control of all health and safety related aspects on the
site: Provided that, where the question arises as to whether a construction health and safety officer is necessary, the
decision of an inspector is decisive.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- That all work is performed by suitably trained and competent persons;
- That all statutory appointments have been completed and all statutory requirements are met;
- That, where required, health and safety committees are established, that meetings are accordingly held
and that the minutes of such meetings are kept and properly filed;
- That all persons are aware of the hazards attached to the work carried out and are fully conversant
with the precautionary measures to be taken or observed to obviate such dangers;
- That the required risk assessments are carried out;
- That discipline is enforced at the construction site at all times; and
- That any other requirements, in terms of health and safety with respect to the responsible area are
met.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 15 of 33
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Legal Appointments
Document Number: HSF-04.5

Construction Supervisor
Construction Regulations 2014 Regulation 8(7)
(7) A construction manager must in writing appoint construction supervisors responsible for activities and ensuring
occupational health and safety compliance on the construction site.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- That the work area has been assessed for health and safety hazards and that all identified workplace
risks are controlled;
- That all work is performed only by suitably trained and competent persons who know and understand
the scope of their authority;
- That all equipment used for the task is safe and maintained to the manufacturer's specifications;
- That the health and safety hazards of any materials used is known and that appropriate HSE controls
have been implemented;
- That all persons are aware of the hazards and risks attached to the work being carried out and are fully
conversant with the precautionary measures to be taken or observed to control such dangers by
sharing Daily Safe Task Instructions with them before any new task is started;
- That discipline is enforced on the tasks under your supervision at all times;
- That the required Planned Job Observations are carried out; and
- That all the prescribed HSE control forms are completed to ensure the above-mentioned steps.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 16 of 33
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Construction Vehicle/Mobile Plant Operator

Construction Regulation 2014 Regulation 23(1)(k)
(k) are inspected by the authorised operator or driver on a daily basis using a relevant checklist prior to use and that
the findings of such inspection are recorded in a register kept in the construction vehicle or mobile plant.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- In terms of GMR 4(1) declare to be fully aware and knowledgeable of the danger attached to operating
this machinery and be conversant with the precautionary measures to be taken or observed to obviate
such dangers;
- In terms of GMR 4(4) declare to be aware that you may not, without permission of your supervisor,
authorise any other person to do your work;
- Your duties are as follows:
o Conduct daily pre-start checks on your equipment;
o Record the results of the inspection on the pre-start checklist provided; Ensure that the pre-
start checklist is at all times kept in the vehicle;
o Report deviations to your supervisor immediately upon identifying the problem;
o Keep the equipment clean and ensure the equipment is cleaned before stopping work; and
o Do not allow unauthorised use of the equipment.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Construction Vehicle/ Mobile Plant Inspector

Construction Regulations 2014 Regulation CR 23(1)
(1) A contractor must ensure that all construction vehicles and mobile plant-
a. are of an acceptable design and construction;
b. are maintained in a good working order;
c. are used in accordance with their design and the intention for which they were designed, having due regard
to safety and health;
d. are operated by a person who-
i. has received appropriate training, is certified competent and in possession of proof of competency
and is authorised in writing to operate those construction vehicles and mobile plant;
ii. has a medical certificate of fitness to operate those construction vehicles and mobile plant, issued
by an occupational health practitioner in the form of Annexure 3.;
e. have safe and suitable means of access and egress;
f. are properly organized and controlled in any work situation by providing adequate signalling or other control
arrangements to guard against the dangers relating to the movement of vehicles and plant, in order to
ensure their continued safe operation;
g. are prevented from falling into excavations, water or any other area lower than the working surface by
installing adequate edge protection, which may include guardrails and crash barriers;
h. are fitted with structures designed to protect the operator from falling material or from being crushed should
the vehicle or mobile plant overturn;
i. are equipped with an acoustic warning device which can be activated by the operator;
j. are equipped with an automatic acoustic reversing alarm; and
k. are inspected by the authorised operator or driver on a daily basis using a relevant checklist prior to use and
that the findings of such inspection are recorded in a register kept in the construction vehicle or mobile plant.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- Are in accordance with CR 23(1)(c) and (k) as a contractor:
o Of an acceptable design/construction;
o Maintained in a good working order;
o Used in accordance with their design and the intention for which they were designed, having
due regard to health and safety;
o Operated by a person who:
 Has received the appropriate training, is certified competent and in possession of proof
of competency and is authorised in writing to operate these construction vehicles and
mobile plant;
 Has medical certificate of fitness to operate construction vehicles and mobile plant,
issued by an occupational medical practitioner in the form of Annexure 3 (medical
certificate of fitness);
o Inspected by the authorised operator or driver on a daily basis, using a relevant checklist prior
to use and that the findings of such inspection are recorded in a register kept in the
construction vehicle or mobile plant
- You shall ensure that, when becoming aware of any health and safety hazards in respect of
construction vehicles and mobile plant, the necessary precautionary measures are taken and enforced.
- You shall further ensure that all requirements of the Construction Regulations are met, at all times.
Upon identifying any shortfalls or hazards, which cannot be successfully dealt with by yourself, the
matter must be brought to the attention of the construction safety officer, where appointed, officer’s,
construction manager’s, manager’s.

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Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Demolition Work Supervisor

Construction Regulations 2014 Regulation 14(1)
(1) A contractor must appoint a competent person in writing to supervise and control all demolition work on site.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- Ascertaining the location of electricity, water, gas and similar services and that those are not affected
by the demolition process;
- That a method statement on the procedure to be followed in demolishing the structure is developed by
a Structural Engineer and followed to ensure that the stability of adjoining buildings and structures are
not affected during the process;
- That such work is performed by suitably trained/competent persons who are fully aware of the
operational dangers involved and conversant with the precautionary measures to be taken or
observed;
- That, during the demolition, the structural integrity is checked at intervals as determined in the method
statement and that adequate shoring or similar means, as may be necessary, be provided to prevent
the accidental collapse of the structure or adjoining structure; and
- That the necessary precautions are taken when any part of the framing of a framed or partly framed
building is removed, or when reinforced concrete is cut.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Fall Protection Officer

Construction Regulations 2014 Regulation 10(1)(a)
(1) A contractor must-
a. designate a competent person to be responsible for the preparation of a fall protection plan;
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- Prepare a fall protection plan for all work carried out from a fall risk position
- Ensure that the fall protection plan in 1 includes:
o A risk assessment of all work carried out from a fall risk position;
o The procedures and methods used to address the risks identified per location;
o The processes for the evaluation of the employee’s medical fitness necessary to work at a fall
risk position and the records thereof;
o A programme for the training of employees working from a fall risk position and the records
thereof;
o The procedures addressing the inspection, testing and maintenance of all fall protection
equipment; and
o A rescue plan detailing the necessary procedure, personnel and suitable equipment required to
affect a rescue of a person in the event of a fall incident to ensure that the rescue procedure is
implemented immediately following the incident.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Fire Extinguishing Equipment User

Construction Regulations 2014 Regulation 29(I)
(i) a sufficient number of workers are trained in the use of fire- extinguishing equipment;
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- Select the most appropriate type of fire extinguishing equipment for the type and nature of fire
encountered;
- Operate the selected fire extinguishing equipment in the prescribed manner in order to try and
extinguish the fire.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Fire Fighting Equipment Inspector

Construction Regulations 2014 Regulation 29(h)
(h) the fire equipment contemplated in paragraph (g) is inspected by a competent person, who has been appointed in
writing for that purpose, in the manner indicated by the manufacturer thereof;
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- That all fire fighting equipment on the above-mentioned premises are inspected weekly and that the
results of such inspection are recorded in on register, which must be available for inspection at all
times;
- That the correct type of fire fighting equipment has been provided, in strategic positions, in relation to
identified fire hazards;
- That such fire fighting equipment remains unobstructed, and in good working order at all times;
- That the positions of fire fighting equipment are suitably indicated by means of symbolic signs and that
such signage remains in a good, clean condition; and
- That all emergency escape routes are signposted, where necessary, and that such routes remain
unobstructed at all times.
- In terms of this appointment you are also required to assist with the implementation and maintenance
of all other fire control measures, as contemplated in Construction Regulation 27.
- You are required to report any deviations emanating from this appointment to the construction safety
officer or construction manager.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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First Aider
General Safety Regulations 3(1)
(1) An employer shall take all reasonable steps that are necessary under the circumstances, to ensure that persons at
work receive prompt first aid treatment in case of injury or emergency.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- To ensure that the first aid box or boxes under your control remain properly stocked to meet all
foreseeable incidents which may occur in your designated area of responsibility;
- To ensure that first aid boxes are properly safeguarded, that the positions of such boxes are properly
demarcated and that the names of first aiders are conspicuously displayed on, or at, first aid boxes;
- To ensure that you keep your first aid certificate current at all times for the duration of this
appointment;
- Should the activities in your area of responsibility involve the use of hazardous chemical substances,
you must familiarise yourself with the material safety data sheet (MSDS) for the particular substance/s,
with particular reference to the first aid measures to be applied in case of an emergency;
- To be readily available during working hours/shifts to administer first aid when required; and
- You will be required to undergo training in order to obtain a valid certificate of competency in first aid.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Incident Investigator
General Administrative Regulations 9(2)
(2) An employer or user shall cause every incident which must be recorded in terms of sub regulation (1), to be
investigated by the employer, a person appointed by him or her, by a health and safety representative or a
member of a health and safety committee within 7 days from the date of the incident and finalised as soon as is
reasonably practicable, or within the contracted period in the case of contracted workers.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- Once you are advised/become aware of such incident, you must immediately arrange/start the
investigation;
- Where reasonably practicable you must visit the site of the incident with the view to establishing the
conditions at the time of the incident;
- Investigate all incidents that occur on the premises within 7 days of the incident and finalised as soon
as possible;
- Record the findings of the investigation on an Annexure 1 form as required in terms of General
Administrative Regulation 9 of the OHS Act 85 of 1993. If the incident results in a claim, report to the
Compensation Commissioner (Compensation of Occupational Injuries and Diseases Act,130 of 1993);
- Report all incidents to the Provincial Director in terms of Section 24 of the Occupational Health and
Safety Act, 85 of 1993
- Report the findings of all investigations to your employer and the HSE Committee
- Ensure that the record of each incident is endorsed by the employer and the chairman of the HSE
Committee
- Ensure all documentation pertaining to incident investigations must be properly filed.
- Keep a register of all incidents – Annexure 1 summary
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Risk Assessor
Construction Regulations 2014 Regulation 9(1)
(1) A contractor must, before the commencement of any construction work and during such construction work, have
risk assessments performed by a competent person appointed in writing, which risk assessments form part of the
health and safety plan to be applied on the site, and must include-
a. the identification of the risks and hazards to which persons may be exposed to;
b. an analysis and evaluation of the risks and hazards identified based on a documented method;
c. a documented plan and applicable safe work procedures to mitigate, reduce or control the risks and
hazards that have been identified;
d. a monitoring plan; and
e. a review plan.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- The identification of the risks and hazards to which persons may be exposed;
- The analysis and evaluation of the risks and hazards identified;
- A documented plan of safe work procedures to mitigate, reduce or control each of the identified risks
and hazards; and
- A monitoring-and-review plan.
- You are further required to ensure that a copies of the latest, updated risk assessments are available,
on site, for inspection and that the construction safety officer, where appointed, construction manager,
(is/are) in possession of such risk assessments.
- Any problems which you may experience in the execution of this appointment must be reported to the
construction safety officer, construction manager/ supervisor.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Scaffold Erector
Construction Regulations 2014 Regulation 16(1)
(1) A contractor must appoint a competent person in writing who must ensure that all scaffolding work operations
are carried out under his or her supervision and that all scaffold erectors, team leaders and inspectors are
competent to carry out their work.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- Interpret basic drawings and instructions required for the erection of scaffolding;
- Co-ordinate resources required for the erection of scaffolding;
- Erect scaffolding under supervision according to basic drawings and instructions in accordance with
safe working methods;
- Dismantle scaffolding under supervision in accordance with safe working methods.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 27 of 33
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Scaffolding Inspector
Construction Regulations 2014 Regulation 16(1)
(1) A contractor must appoint a competent person in writing who must ensure that all scaffolding work operations
are carried out under his or her supervision and that all scaffold erectors, team leaders and inspectors are
competent to carry out their work.
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- In terms of this appointment you are required to ensure that the design, erection, use and inspection
of all scaffolding comply with the requirements of SANS 10085.
- You are further required to ensure that all scaffold erectors and team leaders are competent to carry
out their work and that a procedure is developed to ensure that no scaffold is used before it has been
inspected and declared safe. Apart from the above-mentioned inspection, scaffolding must also be
inspected:
o at least once a week;
o after inclement weather, such as strong winds, electric storms or rainfall;
o after any mishap resulting in jarring, tilting or overloading;
o after alterations; and
o before dismantling to ensure that ties are in suitable positions for dismantling.
- The results of all inspections, including details of any faults found and corrected, must be recorded on a
register, which must be available for inspection on the premises at all times.
- Any problems which you may experience in the execution of this appointment must be reported to the
construction safety officer, construction manager’s.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Stacking and Storage Supervisor

Construction Regulations 2014 Regulation 28(a) and General Safety Regulations 8
(a) a competent person is appointed in writing with the duty of supervising all stacking and storage on a construction
site;
GSR 8
(1) No employer shall require or permit the building of stacks which consist of successive tiers, one on top of
another, unless –
a. the stacking operation is executed by or under the personal supervision of a person with specific
knowledge and experience of this type of work;
b. the base is level and capable of sustaining the weight exerted on it by the stack;
c. the articles in the lower tiers are capable of sustaining the weight exerted on them by the articles
stacked above them;
d. all the articles which make up any single tier are consistently of the same size, shape and mass;
e. pallets and containers are in good condition; and
f. any support structure used for the stacking of articles is structurally sound and can support the articles
to be stacked on it.
(2) An employer shall not permit –
a. articles to be removed from a stack except from the topmost tier or part of that tier; and
b. anybody to climb onto or from a stack, except if the stack is stable and the climbing is done with the aid
of a ladder or other safe facility or means.
(3) An employer shall take steps to ensure that –
a. persons engaged in stacking operations do not come within reach of machinery which may endanger
their safety;
b. stacks that are in danger of collapsing are dismantled immediately in a safe manner; and
c. the stability of stacks is not endangered by vehicles or other machinery or persons moving past them.
(4) Unless a stack is otherwise supported an employer shall take steps to ensure that tiers of stacked material
consisting of sacks, cases, cartons, tins or similar containers –
a. are secured by laying up articles in a header and stretcher fashion and that corners are securely bonded;
and
b. are stepped back half the depth of a single container at least every fifth tier or that, alternatively,
successive tiers are stepped back by a lesser amount: Provided that at least the same average angle of
inclination to the vertical is achieved: Provided further that where the containers are of a regular shape
and their nature and size are such that the stack will be stable, they may be stacked with the sides of the
stack vertical if the total height of the stack does not exceed three times the smaller dimension of the
underlying base of the stack.
(5) Notwithstanding the provisions of sub regulation (4), free-standing stacks that are built with the aid of machinery
may, with the approval of an inspector, be built to a height and in a manner permitted by the nature of the
containers being stacked: Provided that –
a. the stacks are stable and do not overhang; and
b. the operator of the stacking machinery is rendered safe as regards falling articles.

I, ....................................................... the ................................................ for, .......................................... do hereby

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Duties and Responsibilities

- The persons responsible for the building and breaking down of stacks have been properly trained to
perform such work;
- Such work is performed by persons who are fully conversant with the hazards attached as well as the
precautionary measures which should be taken or observed regarding the hazards;
- All stacks are stable and do not overhang and that any stack in danger of collapsing must be dismantled
immediately, in a safe manner and under your direct supervision; and
- Operators of stacking machines are rendered safe against falling articles and that effective measures
have been taken to ensure that the stability of stacks are not endangered by vehicles or other
machinery or persons moving past them.
- You are required to report any deviations emanating from this appointment to the construction safety
officer, construction manager’s.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

Page 30 of 33
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Structure Inspector
Construction Regulations 2014 Regulation 11(2)(a)
(a) inspections of that structure are carried out periodically by competent persons in order to render the structure
safe for continued use;
I, ....................................................... the ................................................ for, .......................................... do hereby
appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
- Inspect structures at least once every six months for the first two years and yearly thereafter;
- Record the results of inspections in an appropriate register and make this information available on
request of an inspector;
- Report all deficiencies in structures to the relevant contractor.
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Legal Appointment
Legal Reference

I, ....................................................... the ................................................ for, .......................................... do hereby

appoint, ................................................ as a, ............................................... for ...............................................
from ....../........../20...... to the completion of the stipulated project.
Duties and Responsibilities
(Please List Duties and Responsibilities here)
Authorized/Designated by
Signature Designation Date

....../........../20......
.....................................................

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Legal Appointment
Legal Reference

I, ....................................................... the ................................................ for, .......................................... do hereby

....../........../20......
.....................................................

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Firefighter Duties Assignment
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4.4 Legal Appointments

Uploaded by

4.4 Legal Appointments

Uploaded by

Legal Appointments

Document Number: HSF-04.5

Assistant Chief Executive Officer

Health and Safety Representative

Health and Safety Committee Member

Health and Safety Committee Chairperson

Assistant Construction Manager

Assistant Construction Supervisor

Assistant Supervisor of Machinery

Confined Space Inspector

I, ....................................................... the ................................................ for, .......................................... do hereby

Duties and Responsibilities

Construction Health and Safety Officer

Construction Vehicle/Mobile Plant Operator

Construction Vehicle/ Mobile Plant Inspector

Demolition Work Supervisor

Fall Protection Officer

Fire Extinguishing Equipment User

Fire Fighting Equipment Inspector

Stacking and Storage Supervisor

I, ....................................................... the ................................................ for, .......................................... do hereby

Duties and Responsibilities

I, ....................................................... the ................................................ for, .......................................... do hereby

I, ....................................................... the ................................................ for, .......................................... do hereby

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