Site Induction Form

• Document No.

• Audit Title

• Company

• Conducted on

  Date

• Prepared by

• Location
  Address

• Company

Description of works

SITE OH&S COORDINATION PLAN

• Has nearest hospital and medical centre locations been identified?

  Yes

  No

  N/A

• Has emergency assembly point location been identified?

  Yes

  No

  N/A

• Has site specific hazards been identified

  Yes

  No

  N/A

• Has the mandatory site safety rules been explained to contractor

  Yes

  No

  N/A

• Has City of greater bendigo contact persons information been identified to contractor

  Yes

  No

  N/A

Service locations / hazards

• Power location

  Yes

  No

  N/A

• Gas Location

  Yes

  No

  N/A

• water location

  Yes

  No

  N/A

• asbestos register viewed

  Yes

  No

  N/A

• Contaminated soil

  Yes

  No

  N/A

• mine shaft

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

AMENITIES

• Has vehicle parking locations been identified or explained?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Have toilet locations been identified?

  Yes

  No

  N/A

• Has water supply locations been identified?

  Yes

  No

  N/A

• Has power supply locations been identified?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are SWMS required

  Yes

  No

  N/A

• Add media

  Media

INCIDENT NOTIFICATION

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

  Yes

  No

  N/A

ADMINISTRATION

• Has the city of greater bendigo Code of Conduct been explained?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Dose contractor have the required PPE

  Yes

  No

  N/A

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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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.

  Yes

  No

  N/A

• 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.

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Yes

  No

  N/A