Title Page

  • Document No.

  • Site

  • Conducted on

  • Company

  • name

  • Who has responsibility for reporting hazards

  • It is your duty to report any hazards, injuries or unsafe practices to management

  • As a worker you have a responsibility to protect yourself and others

  • You will not do any job you do not feel qualified or trained to do safety

  • You are aware that you need to wear work boots with non slip soles

  • You are aware you must wear steel capped boots

  • You are aware you need to wear long pants and shirts plus hat or sun screen for sun protection

  • You are aware of the risk of loose clothing being tangled in machinery

  • You are aware of the need for eye protection when working in the workshop, outdoors or around machinery, chemicals, fences or in the sun.

  • You are aware of the need to wear PPE in hazardous jobs including in the workshop and around chemicals.

  • You are aware that clothes should be cleaned of chemicals, fuels, oils etc after each day at work

  • You are aware of the no smoking rule inside buildings, farm machinery or where their is a risk of igniting a farm fire

  • You are aware of the no illicit drugs rule

  • You are aware of the risk of tetanus, Q fever and Covid and have had the vaccinations

  • You are aware of the no consumption of alcohol rule during work hours

  • You have advised your manager of any medical conditions or medication you need to take

  • You are aware that children are not permitted around machinery unsupervised

  • You are aware of the risk of ear damage with loud noises and the need to wear ear muffs

  • You are aware of the hazards that require you to wear PPE including gloves, masks, respirators,

  • You have taken a chemical handling course before handling chemicals

  • You are aware a helmet must be wore when riding motor bikes or quad bikes

  • You are aware you cannot ride on the back of utes and trucks

  • You are aware of the need to drive at a responsible speed around the farm sheds or near other vehicles in the paddock and around the farm

  • You are aware of the risk of heights and will not climb onto high and dangerous sheds, silos, windmills, houses, trees.

  • You will follow the safe handling instructions on chemicals

  • You are aware of the risks of being under machinery without ensuring the machine cant fall on you.

  • You are aware of how to use fire extinguishers and the fire fighting unit

  • You are aware that before starting a machine you must check it can operate safely

  • You are aware of the hazards of water and will not enter dams or tanks without a water wise partner watching

  • You are aware of the need to report unsafe machinery or equipment or infrustructure to the management

  • You are aware of how to undertake fencing safely

  • You are aware of the risks of being run over by moving machinery

  • You are aware of the risks of moving parts on machinery incl PTOs

  • You are aware to check all electrical appliances are safe before you use them

  • You are aware of the importance of guards on machinery and will replace them when removed

  • You are aware than when a machine has a seatbelt fitted you will use it

  • You are aware of the risks of low power lines and high machinery

  • You are aware of the need to use appropriate harnesses when climbing or at heights

  • You are aware of the contact numbers for emergencies and will carry a mobile phone when working alone

  • You are aware of where the first aid kit is located

  • Before starting work you will let people know what you work plan is for the day, when where you are likely to be

  • You have read the emergency plan

  • You are aware of who is trained in first aid locally

  • You know how to fill in a injury register form

  • I acknowledge that I have personally answered the questionnaire and agree to abide by all the requirements outlined in the induction

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.