Title Page
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Prepared by
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Workers Name
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Position/Title
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Phone Number
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Company Name
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Emergency Contact
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Emergency Contact Phone Number
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Medical Conditions (if any)
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Select date
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Construction Industry Induction Card (photo)
Section 3 - HSE items
Non Negotiables (if the next three items are not ticked the worker cannot proceed to work on site)
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General Construction Induction Card
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Personal Protective Equipment (high vis vest and steel capped boots)
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Housekeeping
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COVID-19
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SWMS (for high risk construction work only. Must be read, signed and a copy retained on site)
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UNDERGROUND SERVICES: If you are digging with a mechanical aid you MUST locate all services in the area prior to digging. You must also talk with the Site Manager before digging and complete a Permit to Dig document.
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Electrical equipment to be tested and tagged (three monthly intervals)
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Emergency Procedures; * location of fire extinguishers * muster point * first aid kit * emergency contact numbers * amenities * nearest medical facility
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Site Specific Start Times
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Weekend Work
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Hazardous Substances Register (Safety Data Sheets)
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Exclusion Zones
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All hazards, near misses, and incidents to be reported to the Site Manager
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No Alcohol/drugs to be consumed on site
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DO NOT alter/tamper/move equipment provided for your safety (e.g. scaffold) or equipment provided for the protection of the environment (e.g. sediment fences)
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High Risk Work Licence? (do you have one? If so, please provide to Site Manager for copying)
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Miscellaneous
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Apprentice/Trainee (if you are an apprentice/trainee you must complete the next section with your supervisor)
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LAST PERSON TO LEAVE SITE MUST SHUT AND LOCK THE GATE
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Inductor's signature
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Inductee's signature
Apprentice/Trainee
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If you are an apprentice or trainee your Supervisor must tick and sign on the form below, what tools you have been trained to use on this site:
Tool
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Nail Gun (Coil type)
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Nail Gun (Framing type)
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Drop Saw
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Power Saw
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Planer
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Angle Grinder
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Drill (Hammer/Large)
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Reciprocating Saw
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Multi-tool
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Fix Out Gun
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Other (please specify)
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I can confirm I have received the HSE induction training and will adhere to all HSE rules and instructions issued by Villa World
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Apprentice/Trainee signature
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Supervisor signature
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Inductor's signature