Safety statement outline for Ireland
European Safety Guide — blank starter worksheet

Use this outline to gather information for a workplace-specific safety statement. It is a planning aid, not a completed safety statement. Start with your actual hazards, risk assessments and arrangements.

Workplace: ____________________
Completed by: ____________________
Date: ____________________

BUSINESS AND WORKPLACE SCOPE
Identify locations, activities and people covered.
____________________________________________________________
____________________________________________________________

MANAGEMENT COMMITMENT
Set out the policy and who has authority and resources to implement it.
____________________________________________________________
____________________________________________________________

RESPONSIBILITIES AND CONSULTATION
Identify responsible roles and how workers are involved.
____________________________________________________________
____________________________________________________________

WORKPLACE ARRANGEMENTS
Describe emergency arrangements, training, supervision, welfare and relevant procedures.
____________________________________________________________
____________________________________________________________

RISK ASSESSMENTS AND ACTIONS
Include the workplace-specific findings and how actions are assigned and checked.
____________________________________________________________
____________________________________________________________

COMMUNICATION AND REVIEW
Explain how staff receive relevant information and how the statement is kept current.
____________________________________________________________
____________________________________________________________

Adapt this starter to the real workplace. See the source guidance and example at:
https://europeansafetyguide.com/ie/en/safety-statement-template/

Independent publisher: Safety Courses LLC. Not a regulator-issued document.