Minor Contract Works

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date
• Location
  Address

• Prepared By

  Select Rex Gower Jordan Richardson

  • Rex Gower
  • Jordan Richardson

Contractor to Complete

• Location of Works
  Address

• Description of Work and Tasks to be undertaken

• Description of Plant and Equipment to be used on site

• Date

  Date

Work can not commence until the following documentation is submitted and approved by the Narromine Shire Council.

• Public Liability (minimum $20 million) REFER CIMS

  Yes

  No

  N/A

• Workers Compensation (Certificate of Currency) REFER CIMS

  Yes

  No

  N/A

• Vehicle and Plant Insurance REFER CIMS

  Yes

  No

  N/A

• Plant Registration Details

  Yes

  No

  N/A

• WorkCover General Construction Induction - White Card

  Yes

  No

  N/A

• Induction (Pro Forma)

  Yes

  No

  N/A

• Specialist licences - Chemical Usage, CASA Cert, special machinery permits

  Yes

  No

  N/A

• Relevant Work Cover Tickets i.e. Plant Tickets/Statutory

  Yes

  No

  N/A

• Risk Assessment

  Yes

  No

  N/A

• Drivers Licence

  Yes

  No

  N/A

• Safe Work Method Statements

  Yes

  No

  N/A

• Traffic Control Plans

  Yes

  No

  N/A

• Plant/Machinery Service Records

  Yes

  No

  N/A

• SDS

  Yes

  No

  N/A

• Other (if required)

  Yes

  No

  N/A

• Name of Contractor

Narromine Shire Council to Complete

• Signature of Contractor

  Sign

• Date

  Date

• The above documentation has been inspected and is approved and authority given to commence work.

• Name

• Position

• Signature

  Sign

• Date

  Date

• Council Contractor Contact Person

• Order Number

• Permit Valid to

• Date

  Date