Title Page

  • Date

  • Report Completed by

  • Task/s this shift

  • Name of First Aid Representative Onsite

  • Pre start meeting conducted, with all workers present.

  • The SDS Register available and accessible to all Personal

  • SWMS Training Completed

  • Employee inductions completed

  • Equipment pre start inspections completed.

  • Plant and equipment on hire this shift and the Suppliers details

  • Notes

  • Related Photos

Employee - Shift Sign On Declaration

  • Daily pre start Sign on by all Service Stream employees is a mandatory requirement.

    By signing this Declaration, you Acknowledge, Confirm and Agree to comply with each of the following individual statements -

    Note : Failing to comply will result in disciplinary action and or termination of employment.

    1. Mandatory Training : You confirm -
    - you will not operate any vehicle, plant, equipment or tooling unless you have previously undertaken and successfully completed the minimum “Service Stream” / “Connect Sydney”, “Government”
    OR
    - You are currently undergoing training and will proceed only under the instruction / direct supervision of a suitably pre qualified trainer.
    - You hold the required tickets and licenses required to be in control a piece of plant, equipment, tooling, vehicle.

    2. OH&S Training, You confirm -

    - OH&S Construction Induction Training - you have successfully completed and obtained the White Card induction training and have the card in possession and ready for inspection if asked.
    - Inductions - you have successfully completed all required Service Stream / Client / Connect Sydney inductions.
    - SWMS Training - you have successfully undertaken task related SWMS training and signed on.
    - Pre Start Meeting - you have attended / signed on to todays pre-start. - SDS Training - you have received adequate training in and have also completed a review of any task related SDS.
    - you will always comply to the related SDS / SWMS relating to the task at hand.

    3. PPE: You agree, you will at all times -

    - to comply to the Service Stream stipulated PPE rules and regulations.
    - to wear the correct PPE that is required and in accordance with the task related SDS / SWMS. - to source, engage, correctly wear and maintain all task, SDS / SWMS stipulated / related PPE, correctly, and as stipulated by the manufacturer.

    4. Conduct, You agree -

    - to present and conduct yourself in a professional, polite and approachable manner whenever representing Service Stream.
    - to promote, maintain and conduct yourself in a manner that ensures a safe working environment for both yourself and also the people and the environment at all times.
    - To follow, implement and enforce the correct task related practices / protocols and procedures, in accordance with the related Service Stream / SDS / Client, mandatory task related protocols and requirements.

    5. Reporting: You agree to -

    - Sign on to this report daily, doing so at the allocated shift start time for this shift.
    - Immediately report all accidents, incidents or near misses, to your Service Stream supervisor / manager, immediately after the situation is deemed safe.
    - Complete all pre start inspections prior to the operation of any vehicle, plant, equipment or tooling.

    6. Plant and Equipment Pre Start inspections: You confirm that -

    - You have completed and signed the required vehicle, plant, equipment and tooling pre start inspections prior to commencement of operation.
    - you will immediately report to your supervisor any issue of fault observed, for subsequent assessment and rectification.

    7. Drugs and Alcohol: You confirm, agree and consent that -

    - you have not and will not take or administer any drugs or alcohol that are illegal, non prescribed and or that may affect your ability to preform a task or duty.
    - you have not consumed or administered any drugs or alcohol for the 12 hour period prior to starting this shift.
    - you will not take or administer illegal or non prescribed drugs or alcohol directly after or during this working shift.
    - you will undertake random drug and alcohol testing when you are instructed or required to do so.
    - you are not under the influence of any drugs or alcohol at the start of this shift.
    - you are fit, well and healthy to undertake all tasks that maybe assigned to you.

  • Shift Type

  • Shift Start Time

  • Employee 1 - Sign on / Declaration

  • Employee 2 - Sign on / Declaration

  • Employee 3 - Sign on / Declaration

  • Employee 4 - Sign on / Declaration

  • Notes

Employee Shift Sign Off

  • Shift End

  • Employee 1 - Sign off

  • Employee 2 - Sign off

  • Employee 3 - Sign off

  • Employee 4 - Sign off

  • Notes

Traffic Control

  • Is Traffic Control Engaged this Shift

  • Cancellation of TC Crew. (If Applicable)

  • TC Company Engaged this Shift

  • Number of Accredited Traffic Controllers Working Onsite

  • TC Setup Time / Road Closure is in Accordance with the ITP / TCP -

  • TC Time Onsite

  • TC Time Off Site

  • Total TC Crew Hire Hours

  • TC Equipment Left Onsite

  • Additional TC Requirements (Next Shift)

  • Additional TC Resources Required Next Shift

  • Notes

  • Related Photos

Linemarking Removal Operation

  • Task preformed

  • Site Location
  • Sweeper engaged

  • Company supplying sweeper

  • Sweeper time on site

  • Sweeper time off site

  • Total area of linemarking removed (square meters)

  • Total waste collected by Suction sweeper (Tonnes)

  • Description of waste type

  • Proposed method of disposal

  • Disposal site address

Completed Works Log (Linemarking)

Job Site 1. Site Details

  • Location
  • Client

  • Task preformed

  • Status

  • Job Progress Status

  • Shifts Remaining

  • Time Onsite

  • Time Off Site

  • Weather Onsite

  • Details of Unexpected Delays / Time Lost.

  • Notes

  • Photos

Job site 1. Instated Linemarking Record

  • L1 or Lane Lines (Total Number of Individual Lines Instated)

  • S1 or Double Centrelines (Measurement in Lineal Meters)

  • E1 or Edge Lines. (Measurement in Lineal Meters)

  • C1 or Merge Lines. ( Total Number of Individual Dashes Instated )

  • Transverse “Stop” Lines. ( Measurement in Lineal Meters )

  • Transverse “Giveway” Dashes. ( Total Number of Individual Dashes Instated )

  • Dragons Teeth ( Total Number of Individual Teeth Instated)

  • Road Signage “40km” ( Total Number of Individual Stencils Instated)

  • Directional Arrows. ( Total Number of Individual Arrows Instated)

  • Notes

Job Site 2. Site Details

  • Location
  • Client

  • Task preformed

  • Shift Status

  • Job Progress Status

  • Shifts Remaining

  • Time Onsite

  • Time Off Site

  • Weather Onsite

  • Details of Unexpected Delays / Time Lost

  • Notes

  • Photos

Job site 2, Instated Linemarking Record

  • Record Measurements as per instruction

  • L1 or Lane Lines (Total Number of Individual Lines Instated)

  • S1 or Double Centrelines (Measurement in Lineal Meters)

  • E1 or Edge Lines. (Measurement in Lineal Meters)

  • C1 or Merge Lines. ( Total Number of Individual Dashes Instated )

  • Transverse “Stop” Lines. ( Measurement in Lineal Meters )

  • Transverse “Giveway” Dashes. ( Total Number of Individual Dashes Instated )

  • Dragons Teeth ( Total Number of Individual Teeth Instated)

  • 40km Zone Stencils. ( Total Number of Individual 40km Zone Stencils Instated)

  • Directional Arrows. ( Total Number of Individual Arrows Instated)

  • Notes

Employee Training Log

  • Name of Trainee

  • Training Type

  • Name of Trainer

  • Total Number of Training Hours (this shift)

Trainee 2

  • Name of Trainee

  • Training Type

  • Name of Trainer

  • Total Number of Training Hours (this shift)

Trainee 3

  • Name of Trainee

  • Training Type

  • Name of Trainer

  • Total Number of Training Hours (this shift)

Trainee 4

  • Name of Trainee

  • Training Type

  • Name of Trainer

  • Total Number of Training Hours (this shift)

Accident, Incident, Near Miss Register

  • If applicable: All occurrences must be reported to Service Stream management and this report completed in detail, immediately and directly after all personal are safe and receiving the appropriate / correct level of cared, AND the site / situation is deemed to be as safe as it possibly.

  • Incident Type

  • Name of Persons Involved

  • Did Anyone Sustain Seriously Injury

  • Did Anyone Sustain Minor Injury

  • Has this matter been Immediately Reported to Service Stream Management

  • Service Stream Manager Notified

  • Have Emergency Services been Called

  • Did Emergency Services Attend the Scene

  • Was anyone hospitalised

  • Detailed Report

  • Related Photos

Traffic Control Incident / Accident Register

  • Details of Accidents/ Incident

  • Has this been Reported to Service Stream Management

Stock / Tooling Request

Stock / Equipment Request

  • Stocks Request

  • List in detail the stock and the amount required

  • Date Required

  • Tooling / Equipment Request

  • Details of tools and or equipment required

  • Date Required

Waste Management

  • 1. Type of Waste

  • 1A. Amount Produced this Shift (Kilograms)

  • 1B. Proposed Method of Disposal

  • 2. Type of Waste

  • 2A. Amount Produced this Shift (Kilograms)

  • 2B. Proposed Method of Disposal

  • 3. Type of Waste

  • 3A. Amount Produced this Shift (Kilograms)

  • 3B. Proposed Method of Disposal

  • 4. Type of Waste

  • 4A. Amount Produced this Shift (Kilograms)

  • 4B. Proposed Method of Disposal

  • 5. Suction Sweeper total waste tonnes

  • Decription

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.