OSAC Services Pty Ltd Company Induction Form

• Induction Date

  Date

• Prepared by

• Location
  Address

Employee Record

• Full name

• Home Address

• Telephone

• Job Description

• Emergency Contact name

• Emergency contact relationship

• Emergency contact Number

Health Deceleration

• Suffered with back injury, back pain or neck pain?

  Yes

  No

  N/A

• Suffered with nerve injury?

  Yes

  No

  N/A

• Suffered with ligament or muscular injuries?

  Yes

  No

  N/A

• Suffer with hearing problems or inner ear damage?

  Yes

  No

  N/A

• Have you suffered from any of the following

  Select Pains in chest High Blood pressure Epilepsy Fainting Attacks Asthma Shortness of breathe Skin trouble Heart Attacks Angina Fits or blackouts Hay Fever Anxiety Or depression Reoccurring Headaches Diabetes None of the above

  • Pains in chest
  • High Blood pressure
  • Epilepsy
  • Fainting Attacks
  • Asthma
  • Shortness of breathe
  • Skin trouble
  • Heart Attacks
  • Angina
  • Fits or blackouts
  • Hay Fever
  • Anxiety Or depression
  • Reoccurring Headaches
  • Diabetes
  • None of the above

• Please give details of any medication you are taking

• Please tick if you are limited in these areas- walking, standing, lifting, using your hands, working at height, driving, climbing ladders?

• Do you have any Physical Disabilities which should be noted?

  Yes

  No

  N/A

• I DECLARE THAT TO THE BEST OF MY KNOWLEDGE THE ABOVE IS CORRECT

  Sign

FOR EMPLOYER ONLY - Have all the below been discussed

• Induction to supervisors and managers

  Yes

  No

  N/A

• Site specific hazards identified

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Job Description

  Yes

  No

  N/A

• Working hours and breaks

  Yes

  No

  N/A

• Health declaration completed and signed forms

  Yes

  No

  N/A

• Employee/self employed record form

  Yes

  No

  N/A

• Employee handbook (for direct employers only)

  Yes

  No

  N/A

• Contract of employment

  Yes

  No

  N/A

• Method of payment advised

  Yes

  No

  N/A

• Travel and expenses

  Yes

  No

  N/A

• Time sheets

  Yes

  No

  N/A

• Insurance of safe system of work

  Yes

  No

  N/A

• Company policies

  Yes

  No

  N/A

• Right to work in the Australia (If on working visa)

  Yes

  No

  N/A

• Night shift opt out form (optional)

  Yes

  No

  N/A

• Copy of any Training Certificates

  Yes

  No

  N/A

• Method statement and SOP explained and signed off.

  Yes

  No

  N/A

• Employee Signature

  Sign

• Employer Signature

  Sign