IM1210.1 Gateway Site Access Accreditation Application for Co-location customers

IM1210 1 4. Click on Browse and locate the file that you wish to embed. 5. Click on the file and then click on Insert. 6. Select the Display as Icon check The completion of this application form and box. provision supporting documentation allows 7. Click on OK. Arqiva to assess your application from a Safety, Health and Environmental Please save the form as a Word document perspective and to gather the required with your supporting documents embedded company information to allow your entry as PDF’s, where possible. All required onto the Gateway Site Access System. The information must be provided. If any information required is dependant on the information is missing, your application will type of access being applied for: be returned to you for amendment and must Only complete this form if you are a co- then be re-submitted. location customer. This application is for Ground Cabin ONLY. Please note: If you intend to use sub contractors to work on Arqiva sites, then All supporting documentation must be these companies must be accredited in inserted into the application form in the their own right. appropriate places. The process for doing this may vary depending on the version of Upon completion of the form, please email Word that is being used. However, the most the electronic copy to common way to do this is as follows. [email protected].

To Embed Files into this Application For any queries please contact Form: [email protected], 01926 416895.

1. Place your mouse cursor where you want to insert the embedded file. 2. Click on the Insert pull down menu and then click on Object. 3. Click on the Create from file tab.

IM1210 2 This application is for Ground cabin access ONLY in order for your organisation to be able to access and maintain your equipment in equipment / rack rooms. By completing and submitting this form you are confirming that your organisation and employees comply with all applicable UK legislation including having applicable training, qualifications and competencies required to undertake the specified work activities. SECTION 1: GENERAL INFORMATION

Please specify in the boxes below if this is a new or renewal accreditation request

New Application Renewal Application

1.1 General Company Information Company Name Company Registered Address

Post Code Tel No Fax No Other Company Locations (if applicable)

Number of Employees

Name of Person Completing this Form Office Number Mobile Number Email Address Who in your organisation is responsible for Health & Name: Safety? Position: Tel: Fax: Email: The Access Regulations Document located on the Arqiva web site requires all individuals on site to have visibility of an approved access document. Please read through the Access Regulations to gain an understanding of how the Gateway system will work. What process will you put in

IM1210 3 place in order to provide your employees with the Gateway Site Access Permits? Where work involves an activity that Arqiva Please read SHE002 and the further deems to be high risk due to the potential for information in the Supporting Information damage to infrastructure, service interruption or Guidance section at the end of this application personal injury, you must submit a construction form. Acknowledge in this box that you have phase health and safety plan / method statement done so and that your organisation and risk assessment for the work on Arqiva sites. understands that it is the responsibility of the The documents must be uploaded when you Requestors (persons raising Gateway access make your access request on Gateway. permit requests) to ensure your company RAMS meet Arqiva minimum requirements. The documentation must meet the minimum guidance I/We acknowledge the above requirements and specified in Arqiva document SHE002. confirm they will be adhered to: Yes No (Delete as applicable) Please state which Arqiva sites you have equipment on?

1.2 Typical Work Activity What typical work activities do you intend to carry out on Arqiva sites? For example, equipment installation, general maintenance, mast painting, wildlife monitoring etc. Please provide as much information as possible as this will help us assess your application and level of risk more accurately.

1.3 Insurance

You are required to have Public Liability Insert your Public Liability Insurance Certificate here Insurance of at least £2million for any one claim. Please provide a copy of your current certificate in PDF format.

You are required to have Employee Liability Insert your Employer/Employee Liability Insurance Certificate here. Insurance. Please provide a copy of your current certificate in PDF format.

DECLARATION

Yes / No I acknowledge that I have read and understood the Arqiva Access Regulations. (These can be found here.)

Yes / No I acknowledge that whilst working on Arqiva sites, all applicable rules and guidance will be adhered to. (These can be found here.)

Yes / No I confirm that the information provided is accurate and I have not knowingly provided false information in support of the application.

Name

Date

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