Title Page

  • Document No.

  • Company

  • Conducted on

  • Location
  • Personnel

  • NAME:

  • CONTACT NUMBER:

  • TRADE / OCCUPATION:

  • TRADE REGISTRATION NUMBER:

  • Photo of card.

  • COMPANY:

  • MANAGER:

  • CONTACT NUMBER:

SITE OH&S COORDINATION PLAN

  • Has nearest hospital and medical centre locations been identified?

  • Has emergency assembly point location been identified?

  • Has site specific hazards been identified to contractor or employee?

  • Has the mandatory site safety rules been explained to contractor or employee?

  • Has Rivergum Homes contact information been identified to contractor or employee?

AMENITIES

  • Has vehicle parking locations been identified or explained?

  • Has first aid kit locations and first aid officers been identified?

  • Have toilet locations been identified?

  • Has water supply locations been identified?

  • Has power supply locations been identified?

  • Has rubbish bin locations been identified and general housekeeping explained to contractor or employee?

  • Has the process of loading/unloading delivery trucks or vehicles been explained?

INCIDENT NOTIFICATION

  • Has the process of reporting any incident, accident, injury or near miss been explained to contractor or employee?

ADMINISTRATION

  • Has the Rivergum Homes Code of Conduct been explained?

  • All contractor or employee's electrical tools and equipment been tested and have current tags?

  • Are Material Safety Data Sheets (MSDS) available where required?

  • Does contractor or employee have appropriate certificates or licensing to carry out works onsite?

SIGN OFF

  • Have you been given the opportunity to ask questions about this form and has your question been answered so you have complete understanding of everything mentioned above?

  • I agree to communicate, report any site specific hazards or incidents to the WHS Manager, Site Manager and other personnel onsite.

  • I understand it is my responsibility to stay safe and not to conduct any activity where I feel incapable or at risk and will notify the relevant personnel if so.

  • I acknowledge I have been inducted in Heath & Safety requirements as outlined above. I am aware of my responsibilities, Policies, Procedures and the Code of Conduct applicable to the work required.

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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.