• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Location
  • Prepared By

Contractor to Complete

  • Location of Works
  • Description of Work and Tasks to be undertaken

  • Description of Plant and Equipment to be used on site

  • 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

  • Workers Compensation (Certificate of Currency) REFER CIMS

  • Vehicle and Plant Insurance REFER CIMS

  • Plant Registration Details

  • WorkCover General Construction Induction - White Card

  • Induction (Pro Forma)

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

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

  • Risk Assessment

  • Drivers Licence

  • Safe Work Method Statements

  • Traffic Control Plans

  • Plant/Machinery Service Records

  • SDS

  • Other (if required)

  • Name of Contractor

Narromine Shire Council to Complete

  • Signature of Contractor

  • Date

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

  • Name

  • Position

  • Signature

  • Date

  • Council Contractor Contact Person

  • Order Number

  • Permit Valid to

  • Date

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