Registering personnel from partner companies
Company data
Name of company*
Address*
Postcode*
City*
Telephone number (company)?*
Responsible representative of the company
First name*
Surname*
Telephone (landline)*
Telephone (mobile)
E-Mail*
The completed form will be sent to this e-mail address
Information about the work to be carried out
Site*
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Biberach
Dortmund
Ingelheim
Ochsenhausen
Rohrdorf
Paris
Reims
Lyon
Vienna
Sant Cugat
Date of access*
Please enter date in format DD.MM.YYYY
End date*
Please enter date in format DD.MM.YYYY
Work or activity to be carried out?*
Building number
Construction site / Place of work
Name of Boehringer Ingelheim representative
E-Mail*
Please note the spelling "@boehringer-ingelheim.com" ,"@boehringer.com", "@microparts.de" , "@biocreen-ms.de" or "@profunda.com". Completed form will be sent to BI representative.
The following employees require access
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
[ + 1 ]
Title
First name*
Surname*
Date of birth*
Please enter date in format DD.MM.YYYY
Reference to the request form
If more than 10 people need access, a further online form is to be used.
If you would like to extend an consisting registration (max. up to 1 year) you simply transmit for the concerned Person/s this online form with updating Date of Access and End Date.
If you require an Entry Approval and/or Access to Building/s please contact your Representative of Boehringer Ingelheim.
Please register only one person per employee-field.
Note for access: Boehringer Ingelheim reserves itself to place spot-check test questions to the "Rules of Conduct for Partner Companies " and with negative result to refuse the admission. With entering and/or driving on Boehringer Site declares her consent to control of their accompanied containers (e.g. suitcase, bags etc.) and its vehicle (passenger compartment, trunk as well as additionally loading space on transporters or lorries) by Security Guard of Boehringer Ingelheim.
Note for the Biberach site:
For access to certain buildings additional training or authorisation may be required. Please clarify promptly access requirements with your Boehringer Ingelheim representative.
Confirmation by the responsible representative of the partner company (entered name is considered as signature)
First name*
Surname*
Safety training*
The Contractor hereby confirms that the above personnel have verified in writing that they have received and understood the safety training for partner companies at Boehringer Ingelheim.
Further information is provided in the presentation on safety training for partner companies .
Privacy statement: Hereby we want inform you, that in context of the settlement of our business relations, Data to your person (name, company, address, picture, telephone number) and Data to the process itself (in and out times, remarks on occurrences, name of superior, training participations) in accordance with legal and Boehringer Ingelheim internal Regulations are documented and stored. If you have questions to the privacy statement, please contact the commisioner for data protection of our house.
The fields marked with an * are mandatory
