Title Page
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Site Inducted
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Inducted on
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Inducted by
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Location
Untitled Page
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Induction number
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Name
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Occupation/trade
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Name of employer
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Your contact number
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CSR card.
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Date of birth
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Card expiratory date
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Experience in Trade
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Emergency contact details
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Name
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Tel number
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Are you taking any medication prescribed or otherwise? (Note: ANY medication can affect your ability to carry out your work safely) YES NO
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Health issues: diabetes, asthma, heart condition, high blood pressure, severe allergies, skin conditions. Please highlight or state here if not listed.
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Do you suffer from any previous or current injury or health condition, or do you have a recurring injury or health condition that could affect your ability to work on site safely? YES NO (Note previous injury could be: back pain, knee or leg joint pain, arm or shoulder pain, sight or hearing issues. Please highlight or state here if not listed). Please circle
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If you have answered YES to any of the above questions, please advise a member of the site management team so we can take any necessary steps to further ensure your health and safety site. (NOTE all information will be treated as confidential)
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I confirm that I have attended the Mascott Site Safety Induction, I fully understand it and my responsibilities regarding H&S. The Site Rules have been communicated to me, I fully understand them and will comply with them. I shall not commence work until I have been briefed on the specific Method Statement and Risk Assessment by my supervisor. I shall comply with any reasonable instructions given by Mascott site management. I will attend toolbox talks that are given on site. I will report any incident or near miss which is in breach of H&S on site. I will report any accident and/or injury that has affected me, or have witnessed, to Mascott Site Management immediately and before leaving my shift. I will report any injury that occurs to me outside of working hours to site management prior to commencing activities on site. I will not operate any plant or equipment that I have not been suitably trained in or authorized to use. If I am not confident in carrying out a task, I will seek advice from my supervisor or Mascott Site Management.
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Signed by Subcontractor
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Date of induction
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Signed by "Mascott" Position in Mascott Inductor
