Duty Manager Form

Name of Organisation/Individual(*)

Please enter a name

Name of proposed Duty Manager(*)

Please enter the name of the proposed Duty Manager

Address

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Telephone Number

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Email address(*)

Please enter a valid email address

Date of Hire(*)

Please select the date of hire

Start Time

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Finish Time

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Brief description of the event(*)

Please enter a description of the event

Approximate number attending

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I am a responsible adult over the age of 25

I have read and understood the guidance for Duty Managers (view document p1-2)

I accept the delegated role and responsibilities of the Principal Duty Manager for the event(s) listed above and will comply with requirements set out in the above guidance

I shall ensure I and any delegated Duty Managers familiarise ourselves with the Hall in respect of layout, exits, fire extinguisher positions and other safety measures prior to the event (view document p3-5)

I undertake that I and any delegated Duty Managers will try to put to rights anything that we find not in compliance during our basic safety inspection or to inform the Secretary of the Hall or other Official of the problem/situation and not to hold the event(s) until the situation is rectified (contact numbers provided: view document p3)

Please accept all terms

The Victory Hall
Dalston
Carlisle
CA5 7QB

UK VAT 317408218
Registered UK Charity Number 1171079