Site Induction Form

• Site conducted

• Conducted on

  Date

• Inductor

• Location
  Address

• Project Name:

• Project No:

• Induction No:

• Date:

  Date

Is a translator needed

• Is a translator needed (Y/N)

  Yes

  No

  N/A

• THE Representative Name

  Yes

  No

  N/A

• Translator Signature

  Yes

  No

  N/A

Personal Details

• Inductee Name:

• Employer:

• Occupation:

• With Years / Months of Experience

• Contact Number:

• Home Address:

• Emergency Contact Name:

• Emergency Contact Contact Number:

• Known Allergies or Medical Conditions:

• Date of Birth:

  Date

Licence Details, Certificates of Competency

• Construction Induction Card Number:

• Drivers License Number:

• Certificates of Competency / Records of Training Apply First Aid expiry date:

• Excavator:

• Trenching Safety Track Awareness issue date:

• Card No. Traffic Management:

• Working with Children:

• Confined Space:

• Height Safety / Harness:

• Electrical Spotter:

• Telehandler under 3t:

• Scissor Lift / Boom Type EW under 11m:

• Backhoe:

• Roller:

• Skid steer loader:

• Trade Licence Number Electrical:

• Plumbing:

• Asbestos (A or B Class) :

• WorkSafe High Risk Licence No # Expiry Date:

• Dogman (DG) :

• Rigger (RB)(RI)(RA):

• Scaffolder (SB)(SI)(SA):

• Boom Type EWP Over 10m:

• Crane Driver (CT)(CO)(C1)(C6)(C2)(CN)(CV):

• Concrete pump operator (PB):

• Forklift (LF):

• Hoist-Man & Materials (HP):

• Materials Only (HM):

• Other:

Site Safety Rules Checklist and Discussion

PPE

• Wearing of safety footwear, high visibility vests and hardhats MANDATORY. Safety equipment including gloves, eye protection, respiratory protection and hearing protections is available from your employer and must be worn as required if in your SWMS.

  Yes

  No

  N/A

SCAFFOLD

• All scaffolding erected where a falls risk of over 4m is present must be erected by a scaffolder to conform to the Australian Standards and manufacturers/suppliers’ specifications. Scaffolds less than 4m are only to be erected by competent persons. If any part of a scaffold needs to be altered, it must be undertaken by an authorised person arranged via your supervisors and or THE management. Before using mobile scaffolds, ensure all wheels are locked full decks installed and access installed.

  Yes

  No

  N/A

Plant & Equipment

• No plant is to be used on site unless it has been inducted by THE. No person is authorised to operate any plant or equipment unless they hold the appropriate licence or certificate of competency. Pre-start must be completed, and logbooks filled out prior to work starting. If any faults are found during the use of plant and equipment, they must be logged in the logbook and the plant taken out of service until your employer and THE deem the plant is safe to use.

  Yes

  No

  N/A

SITE CLEANLINESS

• You must ensure that refuse generated by your work is cleaned up progressively (minimum requirement is daily). Rubbish bins are provided for your use. Please keep site amenities clean and tidy. ALWAYS use sanitary facilities and keep the clean and tidy.

  Yes

  No

  N/A

ELECTRICAL

• Electrical leads must be suspended 2100mm above floor level via insulated hooks and or lead stands. Only power tools and leads that have been tested and tagged within the last 3 months by a qualified electrician are permitted to be used. Faulty or damage equipment must be immediately taken out of service. No switchboards, cables or lights are permitted to be shifted or moved; this must be arranged via THE management

  Yes

  No

  N/A

EXCAVATION & TRENCHES

• Excavation permits MUST be completed before any works commence. No person is to enter any excavation unless ground support and access is installed. Signage and barricades to be erected at all times. If excavation is over 1.5m deep, appropriate fall protection is required to be installed. Excavations are required to be protected at all times which may include being backfilled or covered before you leave the area. Spoil must not impact other trades and site conditions

  Yes

  No

  N/A

PREVENTION OF FALLS

• In all areas where a risk of a fall of 1.5m or more is present, fall protection MUST be installed; via temporary guardrails, permanent guardrails, scaffolding, safety mesh, and covers. Lift shafts are to be fully sheeted out or have cages installed. Excavations are to have fall protection installed or barricades erected at least 1.5m from the excavation. All pits, pockets or penetrations must be covered and signed. If plant is intended to travel over any covers, the covers must be trafficable. NO form of fall protection is to be removed unless permission has been obtained from THE management. If at any stage unprotected areas are identified, you must notify THE management to have the area made safe.

  Yes

  No

  N/A

WELDING AND CUTTING

• All hot works must have a permit issued. Welding screens should be used wherever possible. All equipment must be in good working order and a FIRE EXTINGUISHER must be provided for immediate use. Protective clothing and Equipment must be work during welding and when using oxy kits. 225mm grinders are not permitted on site

  Yes

  No

  N/A

HAZARDOUS SUBSTANDES & DANGEROUS GOODS

• No hazardous substances or dangerous goods are to be used or stored on site unless they have been entered into the register. Current (not more than 5 years) MSDS must be suppled and nominated product included in the SWMS for the process the product is used in.

  Yes

  No

  N/A

LADDERS, PLATFORM LADDERS, CHARIOTS

• Cantilevered chariots and stilts are banned. Ladders may only be used when no other access can be used e.g., scaffold, scissor lift or conventional chariots, provided a risk assessment has been provided to the Project Safety Advisor, Domestic ladders are not permitted onsite. The area around all access ladders is to be clear of all obstructions. Ladders are to be tied off and protrude 900mm above the stepping off point

  Yes

  No

  N/A

EXPLOSIVE POWER TOOLS

• Only trained personnel are to use explosive powered tools.

  Yes

  No

  N/A

ALCOHOL AND DRUGS

• Alcohol and drugs of abuse must not be brought onto or consumed on this site. If you are impaired, you will not be permitted to work on site.

  Yes

  No

  N/A

SUN SAFETY

• Shirts must be worn, no bare backs or singlets. Sunscreen is available for your use however covering the skin is the best protection from UV rays.

  Yes

  No

  N/A

GENERAL PROHIBITIONS

• The following offences will not be tolerated on this site. <br>- Smoking in the amenities/enclosed buildings.<br>- Not using the sanitary facilities.<br>- Verbal abuse, fighting, bullying, harassment, or discriminatory behaviour.<br>- Pedestrians must make eye contact with operator plant and make the operator award of your intentions to pass. Do not enter plant exclusion zone.<br>- Refusal to act on safety instructions issued by the Foreman/Supervisor.<br>- Removal of guardrails or barricades without approval or alternative protection.<br>- Vandalism or stealing of any kind. <br>- All workers are to adhere to project specific site rules.

  Yes

  No

  N/A

Declaration

• I confirm that I have received a site-specific induction and will comply with any THE instruction to ensure a safe working environment for this project.

  Yes

  No

  N/A

• I understand that I may be denied access to the site if I breach the safety or environmental conditions of the site.

  Yes

  No

  N/A

• Employee Name (please Print):

• Employee Signature:

  Sign

• Date:

  Date

• Inductor Sign Off:

  Sign

• Have you signed onto Project Specific SWMS?

  Yes

  No

  N/A