Title Page
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Conducted on
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Prepared by
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Location
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In an emergency, call 000 (or 112 from a mobile)
Site Coordinator's Site Assessment Form
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Activity description
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Weather
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Hazards Checklist – run through all identified hazards and solutions with participants Describe or identify any hazards that may impact participants activities. (List below or use separate Hazards Checklist and attach it.)
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Before you begin your works, make sure you can tick off the following. If you can’t, you should contact Council before continuing with the activities.
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A first aid kit is located on site and all participants know of its whereabouts.
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All participants have signed a Volunteer Registration Form and understand their responsibilities under the Volunteer’s Participation Agreement.
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All participants have been notified of hazards and risks and necessary actions have been taken to remove or minimise them (see hazards checklist, which identifies site hazards).
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All participants are wearing sturdy shoes, appropriate clothing (long sleeves and pants, hat, gloves, eye protection, high visibility top, etc.), and have access to sunscreen and water as well as any other personal protective equipment that is required.
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There is no current fire ban or high fire danger warning, or other extreme weather conditions.
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You are working with at least one other group member on site.
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First aid Person: name and mobile number
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High risk activities: Are you performing any high risk activities (e.g. using chainsaw or chipper)?
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What is the activity?
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Make sure you can also tick off the following:
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The high-risk activity has been identified as necessary in your Agreed Works Plan.
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Only certified volunteers are performing high-risk activities. (Council must have a copy of certificate prior to works.)
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All other participants have been inducted into occupational health and safety and are aware of the risks and site rules.
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If you answered NO to any of the above, do not proceed with the activity. Contact Council.
Hazards Checklist
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Site Coordinator
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Site and activity
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The following hazards have been identified for this site or activity
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Risk: Potential causes of injury or illness to people (volunteers or others)
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Risk: Potential causes of damage to equipment
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Risk: Potential causes of damage to property
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Risk: Potential causes of damage to the environment
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High risks must be included in your Agreed Works Plan or the task cannot be undertaken. Contact the Bushland Management Team on 1300 368 333 if you are in doubt
Volunteer Registration Form
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If you have any questions about any part of the Agreement, please speak with a committee member of the group. You may also contact the Yarra Ranges Environmental Support Officer on 1300 368 333. Advice and assistance is always available.
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Add volunteer
Person
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I, the volunteer (please insert name below) agree to the following (please check all that apply):
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I must observe and adhere to any risk prevention measures identified by the Site Coordinator (group representative) and report any hazards I notice immediately in order to ensure the safety of myself and others
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I must respect the rights, feelings and property of all others associated with the project
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I have consented to having my photo/film taken to be used for the purpose of publications and promotion. (If I do not consent, I understand that it is my responsibility to notify the photographer and deliberately avoid being in any photos.)
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While participating at this event I will not consume or be under the influence of drugs or alcohol
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I take full responsibility for the actions of all minors in my care and understand that I am liable for any incident which occurs as a consequence of their actions
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I have notified the Site Coordinator of any pre-existing medical conditions which may affect my ability to participate in any activities and I grant the Site Coordinator’s authority to seek and/or provide medical treatment as deemed necessary
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I will not behave in any way which is likely to make someone else feel offended, humiliated or intimidated, including unwanted sexual behaviour
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I understand that my placement and the activities to be undertaken at this worksite will be allocated to me at the discretion of the Site Coordinator
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I am aware that if I fail to adhere to these conditions of participation, and/or breach any reasonable safety thresholds, I agree to cease work or leave the worksite
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Signature
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Time in
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Time out
Authorisation of office bearer or agreed representative
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Total number of volunteers
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Total number of volunteer hours
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Authorisation of office bearer (or agreed representative)
I declare that the information on this form is correct and the group has agreed to follow specific instructions, requirements and guidelines in relation to volunteer activities -
Add signature
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Select date
MONITORING (Optional)
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Progress and observations
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Area / amount removed / treated
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WEEDS: Method of removal
- Hand pulling
- Drill and fill
- Spray
- Cut and paint
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FLORA: Total number planted
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FLORA: Species
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FLORA: Unusual / rare flora observed
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Add media
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FAUNA: Species observed (direct sighting)
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Add media
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FAUNA: Species observed (indirect: scats, tracks)
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Add media
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General observations
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Follow up required
