Title Page
-
Job number
-
Site address
-
Conducted on
-
Prepared by
-
The Site Manager/Foreman must use this form to keep record of visits conducted by any person claiming to have a right of entry ( Authorised representative of a Registered Employee Organization- ARRO) under the OHS act. Once the form is completed, a copy must be kept onsite and a copy sent to the JLG Manager/ Director as soon as possible.
-
ARRO name:
Date of entry:
Time entered:
Time exited: -
Entry Permit number:
Date of issue:
Date of expiry: -
Employee organization Representing:
-
Alleged Contravention
Notice of Suspected Contravention attached?
Checklist
-
Did the Authorized Representative produce their Entry Permit as required under S.88 of the OHS act
-
Did the Authorized Representative give notice of the alleged contravention in the approved form
-
Did the Authorized Representative comply with the site requirements for PPE/PPC, induction etc
-
Was the Authorized Representative escorted from entry to exit?<br><br>If yes, by whom?
-
Did the Authorized Representative enquire into matters other than those relating to the alleged contravention?
-
Did the Authorized Representative take any action to cause work to stop?
-
Did the Authorized Representative hinder or obstruct you or other personnel onsite?
-
Did the Authorized Representative intimidate or threaten you or other employees?
-
Did the Authorized Representative give a warning of immediate risk of harm
-
Do you know whether the Authorized Representative wrongly used any information gained at the site that was not reasonably connected to the alleged contravention?
-
Was there a successful resolution?
-
Did you or the Authorized Representative request a Worksafe Inspector to attend?
-
If an Inspector attended, what action did the Inspector take?
-
What advice did the Inspector give?
-
Attach copies of any Improvement Notice or Prohibition Notice or Entry Report and all other relevant documentation
-
Contractor
-
JLG Representative