Rental of spaces for academic or socio-cultural events (1/3)

Fields marked with an asterisk (*) are compulsory.

Details of the company and the legal representative

Name of the institution/organisation/company*

Name and surname of the legal representative*

As the legal representative of the aforementioned Institution/Organisation/Company, you accredit by means of this document the fulfilment of the legal requirements specified in Royal Decree 171/2004, of 30 January, which develops article 24 of Law 31/1995, of 8 November, on the prevention of occupational hazards, in the field of Coordination of Business Activities.

In this respect, it certifies that:

The institution/organisation/company has the following preventive measures in place

Prevention Service (SP)

Own prevention serviceYesNo

Joint prevention serviceYesNo

External prevention serviceYesNo

Others

Specialities of the own Prevention Service

Specialities taken onSafetyIndustrial hygieneErgonomics and PsychosociologyHealth surveillance

Details of the person designated as interlocutor with the UB

Name and surname*

Position*

E-mail*

The company has arranged coverage for accidents at work and occupational illnesses with

Company name/code MATEPSS

Address

Telephone/E-mail

Data referring to the space to be rented and the activity to be carried out

Space to rent

Faculty/Centre

Activity to be carried out

Data relating to the prevention of occupational hazards

Have a Civil Liability Policy in force and up to date with paymentYesNo

You are up to date with your tax obligationsYesNo

You are up to date with your social security and/or self-employed contributionsYesNo

The staff is registered and up to date with the payment of the social security quotes (TC1/TC2)YesNo

It has a prevention planYesNo

It has carried out the Risk Assessment and Planning of the preventive activity of the activities to be carried out by its staff at the UNIVERSITY OF BARCELONA, in accordance with the regulations in forceYesNo

Your staff has been informed and trained on the risks of the activity to be carried out, and the preventive and emergency measures to be appliedYesNo

It undertakes to inform the staff using the space it is allocated about the rules of action in the event of an emergencyYesNo

It undertakes to inform the UNIVERSITY OF BARCELONA immediately of any accidents or emergency situations arising during the development of the activitiesYesNo

Working staff

Staff (One person per line. Specify for each person the name, surname(s) and place of work where the activity will be carried out)

Before the start of the work, the company will be able to document all the information provided in this declaration to the UNIVERSITAT DE BARCELONA. The company undertakes to update it in the event of any changes.

Signature of the company's contact person*
(Draw your signature at the requadre)

Right to information regarding the processing of personal data
(1) The data controller is the General Secretariat of the University of Barcelona. (2) The purpose of the processing is to manage the prevention of occupational risks. (3) You have the right to access your data, rectify them, delete them, oppose their processing, request portability and the limitation of processing, in certain circumstances. (4) You can consult detailed information on the aforementioned processing.

I declare that I have read the information right

I declare that I undertake to provide the information on the processing of UB personal data contained in this form to the employees of the organisation I represent

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