SKOPE Site Safety Induction Form

This form must be completed by all personnel prior to working on or entering a SKOPE Constructions building site. Note: Once this form is completed, you may enter the site until completion of the project, unless requested to carry out the site induction again by the SKOPE Supervisor.

Your first name:*

Your Surname:*

Job / site address:*

Your contact phone number:*

*Preferably a mobile phone number in case you need to be contacted whilst on site. Your employee's number may be used if you do not have a mobile phone.

Phone

Skope Site Supervisor name (select below):*

Select or enter value

Your trade title / type of work:*

CONSTRUCTION SAFETY RISKS BE AWARE & SAFE

Your safety on this construction site is of the highest priority. Approximately 16% of workplace fatalities in Australia occur on construction sites. Key risks on construction sites include:

Falls from heights;
Being hit or crushed by falling objects;
Contact with electricity;
Moving plant and equipment;
Chemical burning or inhalation;

The main illnesses related to construction include:

Silica or asbestos exposure;
Musculoskeletal disorders;
Mental health;

It is important that you understand the following questions and answer them truthfully. If you do not understand them or do not have the necessary skills and experience, let your employer or the Skope Supervisor know before entering the site.

Necessary skills and experience:*

Do you have the necessary skills and experience to carry out the work you will be performing, and do you have the necessary licences or permits to work with the equipment you will be using? For example: Scaffolding ticket, EWP licence, crane or excavator licence, dogman ticket. [If unsure, speak with the Site Supervisor prior to commencing work].

Select

Scaffolders / Crane or plant operators / Working at heights > 2m :

If you are a scaffolder, crane or other plant operator, you must enter your High Risk Work (HRW) licence number here. If you do not have this licence, you MUST NOT carry out high risk work on this site.

Company name of your employer:*

Enter the name of the company you are employed by or the name of your employer if a company name does not exist or is unknown.

General Induction (White) Card number:*

Photo ID & White Card / High Risk Work Licence upload:*

Please take a photo of your General Induction (White Card) and your Photo ID, and upload here (both mandatory): IF APPLICABLE to you, also upload your High Risk Work Licence for scaffolding, crane or plant operation. NO ENTRY is allowed without these.

Drag and drop files here or

Is this project an AGED CARE Facility?*

*Confirm whether this is an active aged care facility i.e. are elderly people living in and around the facility?

Select

Criminal History & Flu Vaccine Verification (for AGED CARE SITES ONLY)*

You are NOT permitted to work on this Aged Care facility without the provision of a Criminal History verification (by law) and evidence you have received a COVID-19 & Flu Vaccination. DO NOT enter this site until you have completed a separate form at the following link:

https://app.smartsheet.com/b/form/104369955ca74d438c3dea7d37e525f1

Has your: - CRIMINAL HISTORY CHECK (for unsupervised work); - COVID-19 VACCINATION & - FLU VACCINATION been provided to Skope?

Select

Next of kin name:*

Specify a person we should contact in the case of an emergency.

Next of kin contact number:*

Are you allergic to any medication?:*

Select

Please specify what you are allergic to:*

Please also inform the Skope Site Supervisor verbally of your allergy, and if you require an "epipen" / emergency medication in the event of an allergic reaction. Advise where your "epipen" or emergency medication is located.

Do you suffer from any temporary or chronic illnesses?*

Select

Please specify what your illness(es) are:

Please specify illnesses that may need to be advised to medical staff in the event of an emergency.

Have you read and understood your company's Safe Work Method Statement (SWMS)?*

If you answer NO, you MUST make the Skope Site Supervisor and your employer aware of this prior to commencing on site.

Select

Have you read & understood your company's Site Safety Management Plan (SSMP)?*

Select

CONDITIONS OF SITE ENTRY

Approved safety hard hats and boots must be worn when instructed or as outlined within your SSMP or SWMS.

Special protective clothing / equipment must be worn when instructed or as outlined within your SSMP or SWMS.

All safety signs and directives MUST be obeyed.

Consumption of alcohol or illegal drugs is prohibited on the site at all times. Any worker who is under the influence of illegal drugs, alcohol or impaired by medication will be denied entry to the site or removed immediately. Workers must not have any alcohol or drugs in their possession or control at the workplace, except for:

a) Drugs prescribed by a medical practitioner, or

b) Non-prescribed medication (being over the counter medications).

Working areas are to be kept clean and free from trip hazards at all times. Cleaning on your behalf will be charged to your company.

Violence or threats of violence will not be tolerated and the police will be called if this occurs.

All dangerous incidents or hazards are to be reported immediately to a member of the Workplace Health and Safety Committee / Site Supervisor as the case requires.

Every worker is expected to assist in the promotion of safety on this site, including keeping the site clean at ALL times, and reporting of poor WHS practices.

WHS Induction Training for Construction Work must have been carried out and the certification uploaded where indicated.

Those without the above, must notify the Site Supervisor and / or a General Site Safety Induction Coarse must be completed before working on this or any building site.

Workers whom are in constant exposure to the sun should use sunscreen, hats and appropriate eye-wear.

If the Skope building site is an operating Aged Care or Child Care facility, you are not permitted to work on this site without providing a Criminal History check and proof of vaccinations to SKOPE prior to commencing any work.

Do you understand and agree to the above "Conditions of Entry" prior to working on this site?*

If you are unsure about or cannot comply with any of these conditions, please notify the Skope Supervisor prior to commencing ANY work. Tick the box below to acknowledge your understanding of these conditions.

SITE SAFETY CHECKLIST

You MUST verify that you are aware of the following items with the Skope Supervisor prior to commencing work.

Amenities*

• Shown location of amenities

First aid station / officer*

• Shown location of first aid station

Fire fighting equipment*

• Shown location of fire fighting equipment

Evacuation*

• Informed on fire evacuation procedure and evacuation meeting point

Entrances and exits*

• Shown location of entrances and exits

Skin protection*

• Shown location of skin protection facilities and aware of risks associated with exposure to sun

Safety Officers*

• Informed of the identity of safety officers • Informed of the identity of first aid officers

Safety equipment / PPE*

• Fully aware of the use of safety equipment specified by your employer and aware of the consequences of not complying.

Clean build*

• Informed on clean build site regulations

Electrical safety and equipment tagging*

• Electrical equipment used by you must be fitted with a current safety test tag, and all electrical leads must be kept off the ground.

Main electrical power lines / electrical hazards*

• You have familiarised yourself with any overhead electrical power lines or electrical safety hazards.

Safety data sheets*

• You have Safety Data Sheets (SDS) on site detailing any dangerous, harmful or flammable material you are using.

Working near heavy machinery*

• You are aware of the dangers associated with working near moving, heavy machinery such as excavators and cranes.

Manual handling*

• You will not manually handle anything that may injure your back / limbs, and you will not stack materials unsafely.

Working at heights > 1.8 metres*

• You understand that working at heights exceeding 1.80m is dangerous, and working without fall protection is prohibited. NOTE: You are NOT permitted to adjust or remove any parts of scaffold, handrails or forms of fall arrest equipment unless you are the appointed, licenced scaffolder for this project.

Power tools and equipment:*

• You will NOT use power tools or other equipment unless you have adequate experience in their use. You WILL notify the supervisor if you require training before commencing.

Floor penetrations / temporary structures*

• You understand that you must be cautious of wall and floor penetrations, and temporary structures at all times.

Hot Work permits / approvals / qualifications*

• You will not carry out welding or similar “hot work” without the relevant qualifications and approvals to do so.

Environmental protection*

• You will ensure that contaminated material / water does not enter the stormwater or sewerage system, and maintain erosion control systems to prevent contamination from occurring.

Harassment in the workplace*

• You will not bully, intimidate or verbally or physically assault any person within or surrounding the work site.

Confirmation of your understanding*

I confirm that I have read & understood this form. I agree to comply with these conditions and am aware that I may be liable to a penalty under the Work, Health and Safety Regulations as a result of my non-compliance. If you have any other concerns or questions, please speak to the Skope Site Supervisor.

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CONSTRUCTION SAFETY RISKS *BE AWARE & SAFE*

CONDITIONS OF SITE ENTRY

SITE SAFETY CHECKLIST

CONSTRUCTION SAFETY RISKS BE AWARE & SAFE