Name *

First Name

Last Name

Phone *

(###)

###

####

Emergency Contant *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

1. Personal Protection Equipment (PPE) to be worn where required *

Yes

No

2. No safety barriers or signs are to be removed without Safety Officers permission *

Yes

No

3. Power leads shall be kept off the ground *

Yes

No

Yes No 4. Power tools and electrical leads to be inspected and certified with current identification tag in accordance with AS/NAS 3760-1996 *

Yes

No

5. Residential Current Devices (RCD) must be used. No unprotected double adaptors or 4-way outlets. *

Yes

No

6. Leads must not exceed 32m in length *

Yes

No

7. Any operators of explosive power tools must be trained in operation and appropriate signs displayed during use *

Yes

No

8.Contractors must hold current licenses and insurance for works to be performed on site *

Yes

No

9. Where it is not practicable to provide scaffold or guard rails, approved safety harnesses must be used *

Yes

No

10. All contractor’s materials and equipment are stored on site at own risk *

Yes

No

11. All incidents or theft or damage will be reported to the Police with the intent of prosecution *

Yes

No

12. Safety audits and inspections will be carried out on site *

Yes

No

13. All building waste to be placed in skip and area of work to be swept and tidied before leaving site *

Yes

No

14. Report any injury to the safety officer *

Yes

No

Please ensure that the following documents are emailed to
adam@turnbullbuilt.com.au

1. SWMS 2. Site Management Plan 3. Copy of Current White Card NOTE: Works cannot commence until these documents have been received

I have emailed my SWMS and SITE MANAGEMENT PLAN *

Yes

No

If No, why;

Comments *

Signed *

Date *