Employee Details

First Name:

Last Name:

Contact Number:

Email Address:

Address:

Do you have any medical afflictions?

Please provide details:

Next of Kin:

Name:

Relationship:

Contact Number:

Employer Details:

Are you a Shadforths Employee?

Employer:

Occupation

Qualifications and Competencies:
Photo of Construction Induction Card (Blue or White card)
Photo of Driver's License or other photo i.d

Do you hold any plant tickets?

Excavator

Grader

Loader

Roller

Other:

Photo of plant tickets:

PPE Management

Site Specific Induction Quiz

Are gloves classed as PPE?

All Shadforths Civil Signs displaying what is to be worn must be obeyed?

If I am a subcontractor, I should expect Shadforths to supply me with PPE on my arrival?

On Fernbrooke Ridge I have to wear PPE at all times unless I am in a safe zone?

I would need to sign for any PPE that I receive.

I am responsible for maintaining my own PPE

Fingerless gloves are okay to wear on site.

The minimum requirements for PPE are: (please select multiple items)

It's okay to wear a cap or straw hat under my hard hat.

If my hard hat was damaged, I would have to wait a year for a replacement.

Site Specific Induction Quiz

What UHF channel is used on this site?

Who is one of the site's first aid officers?

Does Shadforths have a rehab and suitable duties program?

Where is the site's Construction Safety Plan located?

Where is the site's Emergency Procedure located?

Have you been instructed how to complete a Risk Assessment?

Please list at least one risk that is applicable to your works.

Where are the site's Environmental Sediment and Erosion Control Plans Located?

Where can you find information relating to environmental risks?

Who is the site foreman?

Who is your first point of contact after an incident occurs?

When should I contact the above person after an incident occurs?

Where are the spill kits located?

Where is the emergency evacuation point?

In order to go on site, my vehicle must be fit with

What permit do I need before breaking ground?

As plant and personnel interaction is a major risk on site, what are the key controls to put in place?

Will you be operating any plant?

What must I complete before commencing work?

Have you received a Take5 Book?

SWMS

Shadforths SWMS

The below is a list of Shadforths SWMS applicable to Fernbrooke. The first 6 SWMS are mandatory to sign on as they relate to all work conducted on site.

Please check all SWMS that apply to your tasks on site. Your inductor will review this list before completing the induction.

General Civil Works

Manual Handling

Isolation Tagging and Lockout

Working Near Overhead Power Services

Working Near Underground Services

Protection Against Falling Objects

Confined Spaces

Hazardous Chemicals

Transporting and Unloading Plant

Ladders Single or Extension

Using Lasers

Working with Cranes

Using Quick Cuts and Core Drilling

Loading and Unloading of Trucks

Trenching and Excavating

Refuelling

Traffic Control

Concrete

Earthworks

Mobile Plant

Other:

Name of SWMS:

Subcontractor SWMS

If your employer has task specific SWMS that you have signed onto, please check the below box and list the SWMS applicable.

Employee SWMS?

Name of SWMS:

Sign Off:

I agree to uphold my obligations under the WHS ACt 2011 and agree to abide by Shadforths' site entry requirements as informed in the site induction. I have been instructed in the location of the emergency muster, toilets and first aid locations and made aware of how and when to access risk assessments. I will wear the appropriate Personal Protective Equipment (PPE) whilst on site.

Please sign here to confirm your agreement
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.