• Conducted on

  • Officer's Name:

  • Collaborating Officer/s Present if applicable

  • Location
  • Waterway/ Drain Name if applicable


  • Introductions

  • Other observations

Good to Go Assessment

  • •Before you start work •After an extended break or •When circumstances change

  • undefined

  • Are you doing high risk construction work?

  • Identify threats

  • Good to Go Graphic.jpg

Identify the Person/s Present (Person of Interest - POI)

  • What is your full and correct name?

  • Address Person

  • Can you please provide your date of birth?

  • Are you the occupier of the land or premises?

  • Any Other Person/s Present. Please note full name, address and DOB

  • Where possible seek positive identification eg Details of Driver's licence

  • Any other comments

Rights of POI/s

  • • Right to communicate with friend or relative
    • Right to communicate with legal practitioner
    • Right to an interpreter
    • If person is of Aboriginal or Torres Strait Islander descent: right to a support person
    • If person is under 18: right to parent/ guardian/other adult being present.

    If an POI/s requests assistance or these rights apply, take steps to meet their requests.
    If you are unable to secure the assistance they require, you must stop the interview.


  • Was an allegation given to POI?

  • Details of allegation given to POI/s?

  • Sample : I am going to ask you some questions in to the allegation that [state date and nature of allegation, section of Water Act 1989

Caution (if required)

  • Sample - I intend to ask you further questions in relation to this matter but before I do, I must caution you that you do not have to say or do anything as anything you say or do will be recorded and may later be used in evidence.

  • Was an caution given?

  • Details of caution given to POI/s

  • Do you clearly understand the caution?

Body of Interview

  • Select Date and Time

  • Please detail interview of what was discussed

  • Any other comments or questions?

Key Actions

  • Describe key actions

Items seized if required

  • Was any items seized?

  • Document any items siezed


  • Photo (please describe photos and add text or arrows if required)

Potential Offences under Water Act 1989

  • Element of Offences Manual -

  • Select potential offences detected

Other comments

  • Any other comments

Lead Officer

  • The above notes and photos are are a true and accurate record of what occurred .

  • Signature

  • Date

Corroborating Officer

  • I have read the notes of Lead Officer . These notes are a true and accurate record of what occurred and I adopt these notes

  • Corroborating Officer Signature

  • Date and Time

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.