Covid Questionnaire - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Site

• Exec Summary

Disclaimer

• Copyright and Disclaimer
  Work Safety Systems Pty Ltd
  Po Box 306
  Black Rock VIC 3193
  PH: 1300 610 059
  
  Copyright © Work Safety Systems Pty Ltd 2021
  
  This document is, and shall remain the property of Work Safety Systems Pty Ltd. The document may only be used for the purpose for which it was commissioned by INSERT COMPANY NAME in accordance with the terms of the engagement of the commission. Unauthorised use or reproduction of this report, except in its entirety, is prohibited.
  Whilst this report is accurate to the best of the authors’ knowledge and belief, Work Safety Systems Pty Ltd cannot guarantee completeness or accuracy of any data, descriptions or conclusions based on information provided by others. Responsibility is disclaimed for any loss or damage, including but not limited to that of the client, arising from the use of this report or suffered by any person for any reason whatsoever.

COVID Questionnaire

• Is there a QR code sign displayed at the entrance.

  Yes

  No

  N/A

• Are Staff using QR to Sign In?

  Yes

  No

  N/A

• Are all visitors using QR to Sign In?

  Yes

  No

  N/A

• Are there detailed up to date records to capture details of all workers entering the workplace / site?

  Yes

  No

  N/A

• A copy of COVID Safe Plan has been provided?

  Yes

  No

  N/A

• Is there density signage displayed at the entrance and other locations within the worksite.

• Number of Workers Observed in workplace / site:

• Has the employer increased the regularity of comprehensive cleaning by ensuring all areas where workers are working, are cleaned at least daily?

  Yes

  No

  N/A

• Is there a comprehensive Cleaning Register available?

  Yes

  No

  N/A

• Is the employer ensuring limited movement of all workers (including supervisors and on-site specialists) between multiple small-scale sites?

  Yes

  No

  N/A

• What procedures are in place to limit worker movement between multiple locations?

• Mask Compliance - Are all workers and visitors entering the worksite wearing a face mask correctly and as per public health advice.

  Yes

  No

  N/A

• Mask wearing signs are displayed

  Yes

  No

  N/A

• Hand sanitiser is readily available on site

  Yes

  No

  N/A

• Are HSR's together with workers being consulted who are, or are likely to be, directly affected by COVID-19?

  Yes

  No

  N/A

• Are social distancing requirements being met?

  Yes

  No

  N/A

• Are there sufficient hand-washing facilities available on site?

  Yes

  No

  N/A

Construction Specific

• Construction Site Scale (Small or Large)

  Small

  Medium

  Large

• Small Scale Construction Sites: Are employers ensuring that no more than 5 workers (excluding the site supervisor) are at a small-scale construction site at one time?

  Yes

  No

  N/A

• Is there a Covid Marshall - Please note COVID Marshals are required on all construction sites including small-scale construction sites. On small-scale construction sites with a limited workforce capacity, a supervisor or manager can perform the role of COVID Marshal

  Yes

  No

  N/A

• Ventilation Requirements - Have you implemented the ventilation requirements and density quota requirements for your crib room (meeting area), meals area and/or other amenities area? It is a requirement that these rooms have more than just an open door as ventilation.

  Yes

  No

  N/A

• Vaccination Evidence – Have the workers on site provided the duty holder with satisfactory evidence that they have been vaccinated to the level required? The duty holder has the responsibility to provide this information.<br>

  Yes

  No

  N/A

• Early Stage Land Development Sites: Are employers ensuring that early stage land development sites have 10 workers or less per hectare at any one time?

  Yes

  No

  N/A

• Other Comments

Victoria / Melbourne Specific

• Metropolitan Melbourne Only - Surveillance Testing - Has the employer carried out surveillance testing for COVID-19 on its workers in line with Surveillance Testing Industry List and Requirements?

  Yes

  No

  N/A

• Victoria Only - Attestation Submission<br>Have you completed the online attestation submission (via the Services Vic app): https://www.service.vic.gov.au/business/construction-declaration/<br>

  Yes

  No

  N/A

• Victoria Only - Workers Permit - Do the workers onsite have a current workers permit?

  Yes

  No

  N/A

• Vic Construction site - Staff required to use QR code to sign in.

SUMMARY

• Summary