Interflow - General Site Visitor Induction

• Company

• Conducted on

  Date

• Induction conducted by:

Inductee details

• Inductee details

Inductee

• Inductee Name

• Mobile Number

• Next of Kin/ Contact in the event of an Emergency

• Known allergies?

  Yes

  No

  N/A

• Drivers Licence

  Media

• Insert photograph of inductee if without a Drivers Licence

  Media

• Construction Card (White Card/ Blue Card)

  Media

• High Risk Work Licence/ Trade Licence i.e. Electrician

  Media

As a visitor/worker/subcontractor attending an Interflow site I have been made aware of the following points:

• I am aware of the Emergency response process and the designated Assembly point

  Yes

  No

  N/A

• I am aware of and must follow and adhere to the Interflow Life Saving Rules (LSR's)

  Yes

  No

  N/A

• Interflow Life Saving Rules

  

• I am to wear appropriate Personal Protective Equipment relative to the task I am performing and will comply with all mandatory signage

  Yes

  No

  N/A

• 

• I must carry my general Induction card (White Card) at all times on site

  Yes

  No

  N/A

• If an area is barricaded or identified as an exclusion zone I must avoid walking through the area

  Yes

  No

  N/A

• I have been advised who to contact if an incident occurs

  Yes

  No

  N/A

• All safety issues should be reported to an Interflow Representative

  Yes

  No

  N/A

• If engaging in a high risk work activity as stated in Work Health & Safety Regulations 2011, I will submit a Safe Work Method Statement to Interflow for approval and ensure I will have read, understood and signed a SWMS prior to completing the work.

  Yes

  No

  N/A

• Work involving a risk of a person falling more than 2m

• Any work connected with an excavation or demolition

• Work involving structural alterations or repairs

• Work is carried out in or near a confined space

• Work in or near a pier or trench greater than 1.5m

• Work is carried out on or near water

• Work areas are to be kept clean and tidy at all times

  Yes

  No

  N/A

• I am aware all rubbish is to be placed in designated areas

  Yes

  No

  N/A

• Smoking is only permitted in designated areas and cigarette butts must be disposed of appropriately

  Yes

  No

  N/A

• No fighting or over aggressive behavior will be tolerated

  Yes

  No

  N/A

• I understand that if I fail to abide by Interflow's policies and procedures I may be asked to leave site.

  Yes

  No

  N/A

• I certify that I have completed the Interflow Visitors Induction and have been made aware of Site Rules, any Safety Management Plan requirements, risks applicable for this site and expected Code of conduct

  Sign

• Induction given by:

  Sign