Contractor and Supplier WHS Declaration

Quilpie Shire Council 50 Brolga Street Quilpie QLD 4480 ABN: 53 680 434 639

• Document Number

• Conducted on

  Date
• Location
  Address

• Contractor or Supplier has current Public Liability Insurance

  Yes

  No

  N/A

• Contractor or Supplier has current Professional Indemnity Insurance (if applicable)

  Yes

  No

  N/A

• Contractor or Supplier has current Worker Compensation Insurance (or equivalent) (if applicable)

  Yes

  No

  N/A

• Contractor or Supplier and its workers will ensure compliance with relevant WHS and other legislation and Codes of Practice, and any technical standards or codes applicable to the services the company is engaged to supply

  Yes

  No

  N/A

• Contractor or Supplier does not have any Regulatory notices or actions (pending, current or previous)

  Yes

  No

  N/A

• Workers (including contractors) hold qualifications, registrations, tickets, and licences relevant for any work to be completed

  Yes

  No

  N/A

• Workers are fit for work, including alcohol and drugs free at work

  Yes

  No

  N/A

• Plant and equipment are suitable-for-work, well maintained and legally compliant

  Yes

  No

  N/A

Before commencing work, the Company will confirm the following requirements:

• The work to be carried out, when and by whom

  Yes

  No

  N/A

• For high-risk work or construction, have copies of WHS practices and SWMS’s available that will be followed

  Yes

  No

  N/A

• Contact details for the person in control of the work activities

  Yes

  No

  N/A

• That workers have the training, experience, qualifications, and licences to complete the work

  Yes

  No

  N/A

• Workers will have and use required personal protective equipment at all times

  Yes

  No

  N/A

Before commencing work, workers will do the following requirements:

• Complete Quilpie Shire Council WHS Induction

  Yes

  No

  N/A

• Complete the Sign-in and Sign-out to record their attendance at the premises and or work location

  Yes

  No

  N/A

• Have WHS documentation, including safe work method statements (SWMS), safety data sheets, tickets, and licences available where applicable

  Yes

  No

  N/A

During work all Contractor’s (including sub-contractors) and Suppliers must:

• Meet legal obligations and follow all WHS policies, procedures, and rules

  Yes

  No

  N/A

• Comply with inspections audits or compliance monitoring that Quilpie Shire Council requires as part of the work

  Yes

  No

  N/A

• Not perform or omit any act that will put themselves or any other person or property at risk

  Yes

  No

  N/A

• Report any hazards, incidents and near-misses and complete any required reporting process

  Yes

  No

  N/A

• Not interfere with or remove anything provided in the interest of health and safety at the workplace

  Yes

  No

  N/A

• STOP work if it is not safe and take the time to ensure WHS is properly managed

  Yes

  No

  N/A

I confirm the answers given above are true and correct and agree to follow the requirements as above.

• Name & Signature

  Sign

• Company & Position