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Health and Safety form
frm H&S
Business Information
Trading Name:
Trade:
Postal Address:
Postal Address:
Postal Address:
Postal Address:
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Contact Person Name:
*
Phone
*
Email
*
Health and Safety Management
Person in charge of Health and Safety onsite:
*
Phone
*
Email
*
Date of your last Health and Safety Review:
*
How often do you hold toolbox meetings?
*
Not applicable
Frequency
Frequency
Accident/Incident/Near Miss
Have you had a “Notifiable” incident within the past 12 months that was notified to WorkSafe while on site at a conference?
Yes
No
If yes, please provide details.
Please provide a copy of an Incident/Near Miss Form that you use while on site at the Conference
Drop a file here or click to upload
Choose File
Maximum upload size: 10.49MB
Hazard Management – only complete if you are bringing hazardous substances onsite
Will you be bringing any hazardous substances or materials on site?
Yes
No
Section: Hazardous substances
Please list all hazardous substances or materials.
Where are your Safety Data Sheets located?
Please provide a copy of your Hazard Register relevant to the work you will perform onsite (if relevant)
Drop a file here or click to upload
Choose File
Maximum upload size: 10.49MB
Do you identify all hazards and controls that are required before commencing work?
Yes
No
Where do you record these
Are your staff required to wear PPE?
Yes
No
What PPE are your staff and contractors required to wear?
Emergency Procedures
Will your staff have a First Aid Kit onsite?
*
Yes
No
What will your staff do in the event of an incident?
Sub-Contractors – only complete if you are having a sub-contractor complete your build
Do you engage sub-contractors?
*
Yes
No
Section: Sub-Contractors
How do you assess the competency of your sub-contractors Please provide details...
How do you induct your sub-contractors Please provide details...
Training – as relevant to being onsite at the conference
Are your Workers qualified or been trained for the work they will undertake
*
Yes
No
Section: Training
Please describe what training they have received.
Please provide a sample copy of an Employee Training Record
Drop a file here or click to upload
Choose File
Maximum upload size: 10.49MB
Office Use Only
Approved by:
Expiry Date:
Declaration
In submitting this application, we confirm that:
We are aware of our obligations and responsibilities and will comply with the Health and Safety at Work Act 2015 and its subsequent additions and amendments, all industry codes of practice and regulations, and will hold the relevant certification and permits for the work to be carried out.
We will provide our workers with the appropriate personal protection equipment and ensure that they will be fully trained and competent to use the machinery, equipment, tools and substances necessary to carry out the work that this application covers.
Our workers shall agree to attend all site inductions and be bound by any site-specific rules including:
reporting any incident or near miss, and
reporting any potential hazard that has been identified during the course of our
business, and
attending any drug and alcohol screening test in accordance with the clients’ health and safety policy
We will ensure that any Subcontractors we may use will adhere to these requirements.
We will seek approval from the client or site management for disposing of any waste onsite
arising from the contract.
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Health and Safety Onsite Policies and Procedures
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