REPORT TITLE

  • Site conducted

  • Audit Title

ATTENDANCE DETAILS

Inspectors details

  • Inspectors Name:

  • Other inspectors who also attended details:

  • Inspectors name:

Time, date and workplace address:

  • Date and time of entry:

  • Departure Time:

  • Address of attendance entered:

PCBU DETAILS

  • Person conducting business or undertakings details

  • Person Conducting Business or Undertaking:
  • Name of business or undertaking:

  • Main address of business or undertaking:

  • ACN/ABN Number:

  • Additional contact details:

  • Phone number:

  • Mobile number:

  • E-mail address:

  • Trading Name:

Primary Contact details

  • Name:

  • Contact number:

  • Email:

  • Position:

  • Other Persons details
  • Name:

  • Address:

  • Date of birth:

  • Phone number:

  • Position:

HSR Details:

  • Accompanied by HSR:

  • HSR name:

  • Phone number:

  • Position:

Inspection Detail:

  • Legislation:

  • Purpose of Inspection:

  • Major Topic Type:

  • Other Major Topic Type:

  • Inspection Observations:
  • Summary of Inspectors observations:

  • Photo of identified issue/s:

  • Actions of Inspector:

  • Was verbal direction given

  • Other details:

  • Other details

  • Inspection Report Recipient:
  • Report Recipient:

  • Position:

  • Date Delivered:

  • Person's email:

  • Report Delivery Method:

  • Other Delivery Method:

Guidance

  • Guidance to Information to assist with compliance:

  • Guidance to Code of Practice to assist with compliance:

  • Other Code of Practice:

Notes

  • Report notes:

DISCLAIMER

  • DISCLAIMER
    This report only deals with matters the subject of the specific inspection. It does not purport to indicate overall compliance status of the relevant duty holder(s) with work health and safety laws.

  • INTERNAL REVIEW OF CERTAIN INSPECTOR DECISIONS
    If you want to apply for internal review of a decision made by an inspector during this visit, you must do so with the WorkSafe Tasmania within 14 days of the date the decision came to your notice or – in the case of an improvement notice – the lesser of 14 days or the period specified in the notice for compliance (or such longer period as the regulator allows). The Secretary of the Department of Justice must conduct the internal review within 14 days (unless further information is required). If WorkSafe Tasmania does not notify you of the internal review decision within the required time, WorkSafe Tasmania is taken to have made a decision to affirm the reviewable decision. Not all decisions can be internally reviewed and in order to seek internal review of a decision you must be an eligible person. If you are not satisfied with an internal review decision you can apply for an external review to Magistrate Court (Administrative Appeals Division).

    Application forms for internal review, a list of reviewable decisions and a list of eligible persons are available upon request from the inspector, WorkSafe Tasmania by telephoning 1300 366 322 (inside Tasmania) or (03) 6166 4600 (outside Tasmania), or they can be downloaded from our website www.worksafe.tas.gov.au .

    You can contact the WorkSafe Tasmania by telephone1300 366 322 (inside Tasmania) or (03) 6166 4600 (outside Tasmania), fax (03) 617 30206 or by email at wstinfo@justice.tas.gov.au.

  • FEEDBACK
    If you want to contact WorkSafe Tasmania in relation to this inspection by our Inspector other than for Internal Review purposes (see above), please use the following guide:
    to clarify any matter that is covered by the Inspection Report and any associated Notices or Directions contact the issuing Inspector, whose name and contact details appear at the top of this Inspection Report.
    to make comment about any aspect of how this inspection was conducted, contact the inspector's senior management on telephone 1300 366 322 (inside Tasmania) or (03) 6166 4600 (outside Tasmania), fax (03) 6166 4600 or by writing to WorkSafe Tasmania, Hobart - PO Box 56, Rosny Park TAS 7018, 
Burnie – PO Box 287, Burnie TAS 7320 or Launceston – 3rd Floor, 1 Civic Square, Launceston TAS 7250.

  • PRIVACY COLLECTION STATEMENT
    WorkSafe Tasmania collects, uses, discloses and stores information in accordance with the Work Health and Safety Act 2012, other legislation administered by WorkSafe Tasmania and all applicable privacy laws. This includes information collected by WorkSafe Tasmania inspectors or authorised officers. Note that privacy laws do not apply if other laws conflict or allow or require the collection of information, and do not apply to the collection of information by WorkSafe Tasmania to the extent that it is exercising its law enforcement functions and non-compliance with privacy legislation is deemed necessary to fulfil those functions.

    WorkSafe Tasmania privacy information is on our website at www.worksafe.tas.gov.au/resources/personal_information .

  • FURTHER INFORMATION
    WorkSafe Tasmania has a range of publications to explain your legal responsibilities and help you make your premises/site safer. To inquire about these publications, telephone 1300 366 322 (inside Tasmania) or (03) 6166 4600 (outside Tasmania) or visit our website www.worksafe.tas.gov.au .

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.