RASS Course Enrolment Form

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 5th Point, its member companies, and their respective personnel, RASS training instructors (together referred to as Providers) from any liability.

Candidates should be physically fit and unaffected by any medical condition that may prevent them from undertaking the RASS training requirements.

Declaration

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

Principal contra-indications to working at height include (but are not limited to):

• 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.

Risk and Disclaimer of Liability

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 RASS Training and assessment involved in applying for RASS 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 RASS Training 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 has the 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 RASS training and assessment; and
5. I will advise 5th Point should my health or vulnerability to injury change and immediately cease RASS Training activities.

This Candidate Disclaimer and Liability Release shall be construed and governed in accordance with Australian law and the parties submit to the exclusive jurisdiction of the Australian courts.