Safety Declaration Form Template for Indonesia

Create a bespoke document in minutes, or upload and review your own.

4.6 / 5

4.8 / 5

Let's create your Safety Declaration Form

1. Select your governing law and document type:

2. Enter your key requirements:

3. Create your document to edit, review or download

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

Safety Declaration Form

"I need a Safety Declaration Form for our construction company's new high-rise project in Jakarta starting March 2025, including specific provisions for working at heights and crane operations, compliant with the latest Indonesian safety regulations."

Document background

The Safety Declaration Form is a crucial document required under Indonesian safety regulations, particularly aligned with Law No. 1 of 1970 and Government Regulation No. 50 of 2012. This document is typically required before commencing operations, during safety audits, or when undertaking new projects that involve significant safety considerations. It serves as both a legal commitment and a practical tool for safety management, requiring declarants to formally acknowledge their understanding of safety requirements and accept responsibility for maintaining safe working conditions. The form typically includes comprehensive details about safety measures, risk assessments, and emergency procedures, making it an essential component of Indonesia's workplace safety compliance framework.

Suggested Sections

1. Declarant Details: Information about the person or entity making the safety declaration, including full name, position, company details, and relevant registration numbers

2. Scope of Declaration: Clear description of the activities, locations, or projects covered by this safety declaration

3. Compliance Statement: Formal declaration of compliance with Indonesian safety regulations, specifically referencing Law No. 1 of 1970 and other applicable regulations

4. Safety Management Commitment: Declaration of commitment to implementing and maintaining safety management systems in accordance with Government Regulation No. 50 of 2012

5. Risk Acknowledgment: Recognition of potential risks and hazards associated with the work activities

6. Safety Measures: Overview of implemented safety measures, protocols, and control systems

7. Incident Reporting Commitment: Declaration of commitment to report safety incidents and maintain proper documentation

8. Legal Responsibility: Acknowledgment of legal obligations and liabilities under Indonesian law

9. Declaration Validation: Date, signature, and company stamp section

Optional Sections

1. Environmental Impact Statement: Required when activities may have environmental implications, referencing compliance with Government Regulation No. 27 of 2012

2. Specific Activity Declarations: Additional declarations for specialized activities like working at heights or confined spaces

3. Subcontractor Management: Required when declaration covers work involving subcontractors, detailing safety responsibilities and oversight

4. Equipment Certification: Required when declaration involves use of specialized or high-risk equipment

5. Chemical Handling Declaration: Required when activities involve handling of hazardous materials or chemicals

6. Training Compliance: Detailed section about safety training compliance when required by specific regulations or industry standards

Suggested Schedules

1. Schedule A - Risk Assessment: Detailed risk assessment for the declared activities

2. Schedule B - Safety Protocols: Specific safety procedures and protocols relevant to the declared activities

3. Schedule C - Emergency Procedures: Emergency response procedures and contact information

4. Appendix 1 - Certificates: Copies of relevant safety certificates and qualifications

5. Appendix 2 - Insurance: Details of relevant insurance coverage

6. Appendix 3 - PPE Requirements: List of required Personal Protective Equipment for declared activities

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Construction

Manufacturing

Mining

Oil and Gas

Chemical Processing

Transportation

Logistics

Heavy Industry

Infrastructure Development

Maritime Operations

Aviation

Healthcare

Food Processing

Utilities

Telecommunications Infrastructure

Relevant Teams

Health and Safety

Operations

Risk Management

Compliance

Quality Assurance

Facilities Management

Project Management

Production

Environmental Health

Technical Operations

Emergency Response

Occupational Health

Site Operations

Maintenance

Relevant Roles

CEO

Managing Director

Operations Manager

Health and Safety Manager

Site Supervisor

Project Manager

Compliance Officer

Risk Management Director

Facility Manager

Construction Manager

Production Supervisor

Quality Control Manager

Environmental Health Officer

Industrial Safety Specialist

Occupational Health Coordinator

Technical Director

Plant Manager

Safety Engineer

Find the exact document you need

Declaration Of Representative

An Indonesian legal document authorizing a representative to act on behalf of a principal, executed under Indonesian law and notarial requirements.

How a Sales & Marketing Lead uses Genie AI to reduce contract drafting time by 95%

Let's create your Safety Declaration Form

Authors

Alex Denne

Find the exact document you need

Declaration Of Representative

Form Of Declaration

Self Declaration Document

Self Employed Declaration Letter

Nomination And Declaration Form

Resident Declaration Form

Declaration Of Undertaking

Declaration Of Residence

Age Declaration Certificate

Sponsorship Declaration Form

Referee Declaration Form

Supplier Declaration Form

Self Declaration Affidavit

Residency Declaration Form

Medical Declaration Form

Declaration Of Trust Form

Declaration Of Solvency Form

Declaration Of Identity Form

Declaration Of Goods Form

Declaration Form For Courier

Customs Declaration Form

Custodian Declaration Form

Beneficial Ownership Declaration Form

Form 1 Self Declaration

Self Declaration Certification

Primary Producer Declaration

Declaration Of Independent Contractor Status Form

Declaration Letter

Sponsorship Declaration Letter

Relationship Declaration Letter

Self Declaration Letter

Personal Self Declaration Letter

Declaration And Certification Of Finances

Birth Declaration Form

Declaration Of Finances

Sworn Declaration Form

Quarantine Declaration Form

End User Declaration Letter

Third Party Declaration Form

Declaration Form For International Travel

Declaration Of Trust

Visa Declaration Form

Simple Declaration Form

Declaration Of Ownership Form

Declaration Of Interest Form

Background Declaration Form

Student Declaration Form

Loan Declaration Form

Guardian Declaration Form

Plagiarism Declaration Form

Citizenship Declaration Form

Tax Declaration Form

Asset Declaration Form

Address Declaration Form

Staff Declaration Form

Wealth Declaration Form

Patient Declaration Form

Partner Declaration Form

Dependent Declaration Form

Self Declaration Form

Driver Declaration Form

Import Declaration Form

Financial Declaration Form

Vendor Declaration Form

Safety Declaration Form

Compliance Declaration Form

Copyright Declaration Form

Beneficiary Declaration Form

Beneficial Owner Declaration Form

Rent Declaration Form

Relationship Declaration Form

Medical Self Declaration Form

Client Declaration Form

Applicant Declaration Form

Annual Declaration Form