This document is a visitor indemnity form for L&T Construction, Water & Effluent Treatment IC. It contains information about the visitor such as name, contact number, company, and purpose of visit. The visitor declares that they are physically fit and not under any medication. They agree to adhere to safety rules and regulations, wear required PPE, remain with their guide, and not hold the company liable for any harm. The form also captures emergency contact details and confirms the visitor understands evacuation procedures.

1. L&T Construction, Water & Effluent Treatment IC
Visitor Indemnity Form
Doc No IA-00-F Revislon lo 06 Date 30/07/2021 Page 1 of 4
Project/Site/Locatlon felle Plo
Dateofvist 3/1o/202 2
Purpose of visit P.D Boodd oo d
Company NameSri Het tíans perst
Contact number 19 S 711 36
L,(NAME)
hereby declare that I am physically fit and currently not under any prescribe medication.
I agree to adhere to the L&T Construction, WET IC's In-House Rules and Regulation
on
Environmental, health and safety and other related requirements that may apply. I
further agree to always wear the mandatory Personal Protective Equipment (PPE)
within the project work area and always remain with my guide.
_(NRIC/FIN/PASSPORTNO.)
| understand that failure to adhere with the instructions given during the EHS Induction
training will be resulted to my own risk, ill health, injury, and incident.
l agree not to hold the main occupier L&T Construction- Water Effluent Treatment IC,
liable for any accountabil1ity, harm or loss of whatsoever nature that may occur to me.
undertake to refrain from performing, supervise and or command instruction during any
work
activity/processlexecution and shall alert my host of any unsafe act or unsafe
condition, which I may encountered or foresee.
I read and understood the site information brochure, site organizational chart and site
map provided. I understood the emergency evacuation procedure and assembly point,
where Ihave to evacuate in case of any emergency and natural calamity.
Stgnture
EMERGENCY CONTACT PERSON
Rau
Name
Relationship
Contact No:
26/2 S 30/
Realze Ihe Vision of Zero Harm" by lmproing EHS Performance through meaningful Engagement of Workforce
EHS
Department- HQ, WET IC OLarsen and Toubro Limited, Construction All Rights Reserved nEW EHS