Please email this completed form to sam.sherlock@chesterfield.gov.uk
Name
Address
E-mail
Telephone
Which of the following duties will you be able to carry out?
Clear snow from footways/pavements and treat? Yes No
Storage of salt (in 25 kg bags)? Yes No
Monitor and report empty grit bins? Yes No
Provide information to Derbyshire CC on local conditions? Yes No
Specific details of areas you intend to treat
Road (eg Main Road, Brimington) From (eg no 85) To (eg Corner Shop)
If you follow the training and take sensible precautions, you will not being held
liable if someone slips on a footway you have cleared/treated as you will be
covered by the council’s liability insurance
Have you read and understood the training document, and
watched the video that includes a grit spreading
demonstration?
Yes No
Fit to participate declaration
Carrying out the duties of a snow warden can be physically demanding and tiring.
If you are pregnant or have any pre-existing health problems, eg angina or back
pain, or you are not sure whether you are fit enough to carry out the work involved,
please seek medical advice from your GP before you complete this form
Do you consider yourself physically capable of carrying
out the duties involved?
Yes No
Name: Date:
Snow warden questionnaire
