Cadent Your Ansty Life Portal - Occupational Health Parking Form

Staying Safe at Ansty

Occupational Health Parking Application

An Occupational Health parking space is an allocation made due to the nature of a medical condition that you may have, meaning that you rely on your car and cannot make alternative travel arrangements including using anything other than single use occupancy vehicle. (i.e., can’t car share) due to a lesser temporary or permanent medical conditions.

As part of the preferential parking application process, we request that you submit the following information and include confirmation of either information type.

To ascertain a preferential parking space, you must have your Line Manager approval which supports your request for preferential parking.

We are happy to meet you to discuss any requirements. Spaces are limited and are allocated on a 3-month maximum basis before the application will be reviewed again.

If you require more space, please use the reverse of this sheet. If you need to use additional paper, please ensure that all sheets are attached to the submission. You will be contacted once your submission has been reviewed.

Name *

Email Address *

Your vehicles registration *

Line Managers Name *

Line Managers Email Address *

Line Managers Contact Details *

An email/supporting letter with my line manager’s approval for a preferential parking space *

Confirm

Note: A Line Manager’s approval of a preferential parking space may be as a result of a Doctor’s certificate or an Occupational Health recommendation. Copies are NOT required but may support your decision to request such a space

Please state your reason for wanting preferential parking *

For how long this is required: No longer than 3 months *

Phone

Ansty Life