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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.