General Information

Brief description of work to be performed

General Induction

Department Health, Safety and Wellbeing (HSW) Policy

Required conduct/behaviour

High or extreme risk as identified in the OHS Risk Register related to the works to be undertaken

Security access arrangements / Traffic Management Plan

Emergency management

First aid and amenities

Hazardous Substances and Dangerous Goods stored on site

Hazard and incident reporting

Current Asbestos Management Plan and Division 5 Audit Report

Confined Space Entry Permit

Information to be provided by the Contractor

Licence details

A copy of the current contractors Public Liability Insurance Certificate of Currency (minimum ten million sum insured)

A copy of the current Workers Compensation Insurance Certificate of Currency

Current Working with Children Check

Safe Work Method Statements (SWMS)

Personal Protective Equipment (PPE)



I have been provided with and understand the information (as indicated above) and will comply with the safety instructions listed in the Safe Work Method Statement (or equivalent).

Contractor (Name and Signature)

I have provided the contractor with the relevant Department and site-specific information related to the works to be conducted.

Workplace Representative (Name and Signature)