Online Application for CBH Registration

CBH is a national scheme which has been developed in consultation with key stakeholders across the Construction Industry; it is an independent, not-for-profit organisation bringing together those who work in construction and those providing OH services by the setting of industry wide standards.

IF YOU ARE AN OCCUPATIONAL HEALTH SERVICE PROVIDER (OHSP) AND WISH TO BECOME REGISTERED WITH CBH, HAVING READ THE TERMS AND CONDITIONS, PLEASE COMPLETE THE FOLLOWING QUESTIONNAIRE AS FULLY AS POSSIBLE. If for any reason you are unable to complete this form online you can download it by clicking here

CBH IS COMMITTED TO RAISING THE STANDARDS OF OCCUPATIONAL HEALTH WITHIN THE INDUSTRY AND STRIVES TO ENCOURAGE OHSP’S TO BECOME ENGAGED WITH THIS SCHEME, IT IS INTENDED THEREFORE THAT THE REGISTRATION SCHEME, WHILST THOROUGH, SHOULD BE STRAIGHTFORWARD. IF YOU HAVE ANY QUERIES WITH THE COMPLETION OF THIS APPLICATION OF HAVE ANY COMMENTS PLEASE DO CONTACT CBH.

Please complete all fields marked *
General Information :
^*Name of primary contact:
^*Title :
^*Qualifications :
^*Name of Organisation :
^*Main Address :
Addresses of all other premises you operate from :
Address 1 :
Address 2 :
Address 3 :
Address 4 :
^*Main telephone number :
Mobile telephone number :
^*E-mail address :
Website address :

For invoicing purposes :
^*Contact Name :
^*Address :
^*Telephone :
^*E-mail address :
Financial / Credit History :
^*I / We agree to pay our account in accordance with your terms which are 14 days from date of invoices :
^*Please provide details of any outstanding County Court or other Court Judgements made against your organisation in the last 3 years :
^*Please provide details of any outstanding claims or litigation against your organisation :
Business Overview :
^*Year business established :
^*No of full & part time direct employees :
^*VAT registration number :
^*Company registration number :
^*Registered Office Address :
^*Is your organisation listed on the Data Protection register :
^*Registration number :
Please give details of your organisation's Employers Liability Insurance (ELI) :
^*Insurer :
^*Address of insurer / broker :
^*Policy Number :
^*Expiry Date :
^*Limit of indemnity :
Please give details of your organisation's Public (third party) Liability Insurance :
^*Insurer :
^*Address of insurer / broker :
^*Policy Number :
^*Expiry Date :
^*Limit of indemnity :
Please give details of your organisation's Professional Indemnity Insurance :
^*Insurer :
^*Address of insurer / broker :
^*Policy Number :
^*Expiry Date :
^*Limit of indemnity :
Personnel :
^*Name of your Chief Medical Officer :
^*Qualifications :
OH Physicians :
^*How many do you employ? :
^*How many do you have access to? :
^*How many hold :
^*The Diploma in Occupational Medicine :
^*Associate of the Faculty of Occupational Medicine :
^*Member of the Faculty of Occupational Medicine :
^*Do you employ any HSE appointed Dr's? :
^*Please Tick :	Lead Asbestos Ionising Radiation
OH Nurse Advisors :
^*How many do you employ? :
^*How many do you have access to? :
^*How many hold :
^*The Diploma in Occupational Health :
^*A Degree in Occupational Health :
^*A Certificate in Occupational Health :
^*RGN with no OH qualification :
Technicians :
^*How many do you employ? :
^*How many do you have access to? :
^*How many hold Qualifications:
Please provide details :
Administrators :
^*How many do you employ? :
^*How many do you have access to? :
^*Do they all sign a confidentiality agreement? :
Please provide details :
Professional Institutions / Trade Associations / Regulatory Bodies :
^*Do you ensure all employees are members of Professional Institutions / Trade Associations? :
^*How do you check? :
^*Do you ensure all employees are registered with regulatory body e.g. NMC/GMC :
^*How do you check? :
Capacity :
^*Does your organisation offer a UK wide OH service? :
^*If 'No' please specify the geographical area you cover :
^*Do you have a mobile screening unit? :
^*If 'Yes' what services / equipment does this include? :
^*Do you sub-contract any services? :
^*Details :
^*How do you ensure competencies? :
Management Systems :
^*How do you capture and store data? :
^*Do you use OH database software? :
	Beskpoke ? 'Off the shelf' package?
^*How do you measure performance to your clients? :
With specific reference to :
^*Management reports to clients :
^*Health surveillance outcomes :
^*Appointment times :
^*Is your organisation ISO accredited? :
^*Please give details :
Equipment :
Please indicate which of the following equipment you have :
^*Spirometer :
^*How many? :
^*Audiometer :
^*How many? :
^*Sound Booth :
^*How many? :
^*Vision Screens :
^*How many? :
Other :
^*Is all the equipment calibrated as per manufacturer's recommendations? :
What process do you have in place to ensure re-calibration? :
Health and Safety :
^*Does your Organisation have a formal Health and Saftey Policy? :
^*Please give details of how you ensure your company complies with its responsibilities under the HaSaW Act :
^*Has your organisation undertaken risk assesments for work activites? :
^*Please give details of how you ensure your company complies with its responsibilities under the HaSaW Act :
Staff :
^*Do you use agency / temporary staff for ad-hoc work? :
^*If 'Yes', please confirm how you assess their suitability and competance to undertake the work :
^*Do you keep proper and up to date records for all your staff? :
^*If 'Yes', please give details :
Competence :
^*Do you arrange employee training? :
^*If 'Yes', please give examples :
^*How do you ensure staff are competent to undertake tasks? :
^*What process do you have in place to ensure CPD requirements are met? :
^*Do you undertake clinical supervision :
^*If 'Yes', please give examples :
^*Do you conduct regular clinical audits :
^*If 'Yes', please give details :
^*What do you provide in the way of employee induction :
Experience of Construction :
^*Are you registered with 'Link Up' / Achilles? :
What knowledge and experience do you have of the Construction Industry? :
^*Please give details :
^*Please provide examples :
^*Can you provide any references? (Preferably Construction Employers) :
^*Please give details :
Other :
^*Please give any further information to support your application :
Declaration - Please tick boxes: I declare that to the best of my knowledge the information I have supplied in this application is fully up to date and accurate. I accept that a failure to provide fully up to date and accurate information may invalidate my application or provide grounds for a withdrawal by CBH of my registration. I accept and agree to meet the terms and conditions of registration with CBH a copy of which is available at the following link and which I have read carefully. I enclose evidence where this has been requested I agree to pay the non-refundable administration fee of £50.00+VAT: (Your application will not be processed until payment received) By BACS - Payments to: HSBC Bank PLC Sort Code 40-18-22 Account – 81817302 OR By Cheque - payable to 'Constructing Better Health'

VAT No: 914 8554 08 | Contact Centre: 0845 873 7726 | email: info@cbhltd.co.uk

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