IRATA Enrolment Form NZ

CANDIDATE DISCLAIMER AND LIABILITY RELEASE

This is an important document — please read it carefully before signing as you are accepting sole responsibility for your own health and medical condition and absolving IRATA, its member companies, and their respective personnel, training instructors and IRATA assessors (together referred to as Providers) from any liability.

Rope access at altitude or depth is an intrinsic component of training and assessment. Therefore, candidates should be physically fit and unaffected by any medical condition that may prevent them from undertaking their training requirements or performing manoeuvres required during assessment.

I declare that I am in good health, physically fit and consider myself suitable to undertake rope access training and assessment. I do not have any medical conditions or contra-indications that may prevent me from working safely.

• prescribed medication that may impair physical and/or mental function;
• alcohol or drug dependence;
• diabetes, high or low blood sugar;
• high or low blood pressure;
• epilepsy, fits or periods of unconsciousness, e.g. blackouts;
• vertigo, giddiness or difficulty with balance;
• heart disease or chest pain;
• impaired limb function;
• musculoskeletal issues, e.g. back pain;
• psychiatric illness;
• fear of heights;
• sensory impairment, e.g. blind, deaf.

I understand that rope access at altitude or depth, and the training and assessment in respect of it, carries risk to myself and others of personal injury (including permanent disability and death) because of the possibility of falls and collisions and is a strenuous activity.

On behalf of myself and my estate, I irrevocably release the Providers and their officers and personnel from any and all liabilities, claims, demands and expenses including legal fees arising from or in connection with my undertaking rope access training and assessment involved in applying for IRATA certification.

By signing this declaration, I warrant and acknowledge that:

1. the information given by me is correct and will be relied upon by the Providers;
2. to the best of my knowledge and belief, engaging in rope access activities would not be detrimental to my health, wellbeing or physical condition or to others who may be affected by my acts or omissions;
3. a member company or assessor hasthe right to exclude me from training or assessment if they have concerns over my health, fitness or attitude to safety;
4. (save where the Providers cannot exclude their liability by law), I accept that this Candidate Disclaimer and Liability Release remains legally binding even if the warranties and declaration given by me are untrue and I accept the risks involved in undertaking the training and assessment; and
5. I will advise IRATA should my health or vulnerability to injury change and immediately cease rope access activities unless approved to do so by a medical doctor.