Sheet No.

1 of 37

IGC3 The Health and Safety Practical Application

Candidate and course provider declarations:
For completion by the candidate:
I declare that the work submitted for this practical application assessment ie. the completed observation sheets
and the report to management, is my own work. I recognise that contravention of this statement constitutes
malpractice and may result in my being subject to the penalties set out in the NEBOSH Malpractice policy.

Name (Print)

_______________________________

Signature

_______________________________

Date

_______________________________

For completion by a course provider representative (e.g. internal practical

assessor):
I declare that the work marked is identical to that received from the candidate. I recognise that contravention of
this statement constitutes malpractice and may result in my being subject to the penalties set out in the NEBOSH
Malpractice policy.

Name (Print) _______________________________

Signature

_______________________________

Date

_______________________________

For completion by the course providers internal practical assessor:

I declare that I have marked this work and am both qualified and approved by NEBOSH to do so. I recognise that
contravention of this statement constitutes malpractice and may result in my being subject to the penalties set out
in the NEBOSH Malpractice policy.

Name (Print) _______________________________

Signature

_______________________________

Date

_______________________________

NB: This declaration must be completed in full, submitted and retained with
the candidates script. If this declaration is not submitted the candidates
result may be declared void.

APPENDIX 4
Prepared By:

Dated //

Sheet No. 2 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
Risk:
01
Consequences:

Location:

Hazard:
Risk:
02
Consequences:

Location:

Hazard:
Risk:
03
Consequences:

Location:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 3 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
Risk:
04
Consequences:

Location:

Hazard:
Risk:
05
Consequences:

Location:

Hazard:
Risk:
06
Consequences:

Location:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 4 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
Risk:
07
Consequences:

Location:

Hazard:
Risk:
08
Consequences:

Location:

Hazard:
Risk:
09
Consequences:

Location:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 5 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
Risk:
10
Consequences:

Location:

Hazard:
Risk:
11
Consequences:

Location:

Hazard:
Risk:
12
Consequences:

Location:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 6 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
Risk:
13
Consequences:

Location:

Hazard:
Risk:
14
Consequences:

Location:

Hazard:
Risk:
15
Consequences:

Location:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 7 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
Risk:
16
Consequences:

Location:

Hazard:
Risk:
17
Consequences:

Location:

Hazard:
Risk:
18
Consequences:

Location:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 8 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
Risk:
19
Consequences:

Location:

Hazard:
Risk:
20
Consequences:

Location:

Hazard:
Risk:
21
Consequences:

Location:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 9 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
22

Risk:

Consequences:

Hazard:
23

Risk:

Consequences:

Hazard:
24

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 10 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
25

Risk:

Consequences:

Hazard:
26

Risk:

Consequences:

Hazard:
27

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 11 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 12 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 13 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 14 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 15 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 16 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 17 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 18 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 19 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 20 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 21 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 22 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 23 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

APPENDIX 4
Prepared By:

Dated //

Sheet No. 24 of 37

GC3 THE HEALTH AND

SAFETY PRACTICAL APPLICATION

Candidates observation
sheet

Student name :

Student no:

Place inspected:
Date of inspection /
S. N

/
Control measures
Immediate and longer term
actions

Observations
(Hazards and consequences)

Timescale

Hazard:
28

Risk:

Consequences:

Hazard:
29

Risk:

Consequences:

Hazard:
30

Risk:

Consequences:

Prepared By:

Dated //

Sheet No. 25 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Date of review: / /

INTRODUCTION:

Prepared By:

Dated //

Sheet No. 26 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Prepared By:

Date of review: / /

Dated //

Sheet No. 27 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number: 00270928
Location: Jubail Commercial port (Construction Site) Date of review:09/03/2015

Executive Summary:

Prepared By:

Dated //

Sheet No. 28 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Prepared By:

Date of review: / /

Dated //

Sheet No. 29 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Date of review:

Main Findings of the Report:

Prepared By:

Dated //

Sheet No. 30 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Prepared By:

Date of review: / /

Dated //

Sheet No. 31 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Prepared By:

Date of review: / /

Dated //

Sheet No. 32 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Prepared By:

Date of review: / /

Dated //

Sheet No. 33 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Prepared By:

Date of review: / /

Dated //

Sheet No. 34 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Date of review:

Conclusion:

Prepared By:

Dated //

Sheet No. 35 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Prepared By:

Date of review:

Dated //

Sheet No. 36 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number: 00270928
Location: Jubail Commercial port (Construction Site) Date of review:09/03/2015

Recommendation

Likely resource
implications

Priority

Electrical Safety.

Prepared By:

Dated //

Target date

Sheet No. 37 of 37

INTERNATIONAL GENERAL
CERTIFICATE Candidate report template (2011 specification)
UNIT IGC3 THE HEALTH AND
SAFETY PRACTICAL APPLICAITON
Student number:
Location:

Prepared By:

Date of review:

Dated //