Isle of Wight Council

Health and Safety General Enquiry Form

Please complete the form giving as much information as possible about the nature of your enquiry to help us deal with it more effectively. All information provided will remain confidential.

If your enquiry is about specific premises please provide the address below:

Company Name

	Building/house name/number
	Street address
	Town Name
	County
	Postcode

Please give details of your enquiry below:

*

Please type in the detail of your enquiry

If you would like a response to your enquiry please provide your contact details below:

	Title
	Building/house name/number
	Street address
	Town Name
	County
	Postcode
	Tel Number (include area code)
	Email address
	Fax

Please indicate which method you would prefer us to use to contact you?

Post Telephone Email

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

For all communications regarding this form please quote the following reference information

	Reference number:
	Date of submission:

Date printed: 07/03/2013