FormsOnce per job:Risk Assessment ToolSWMS Inspection ToolSite First Aid InformationOngoing:Weekly Toolbox Talk RecordJSA Pre-Start RecordPer Incident:Hazard Report Site Housekeeping & First Aid Information Person Completing this Form: Sean Millar Zac Ozolins Other Name if not listed above: Project * Work Site Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Contact List * PCBU: Zac Ozolins, Director, 0413 001 239 other PCBU name if other selected above: * Site Supervisor: Sean, Team Leader, 0474 078 592 Zac Ozolins, Director, 0413 001 239 Other Site Supervisor name if other selected above: Housekeeping * I understand I need to have pre-dig information prior to digging work. Visit https://www.byda.com.au/before-you-dig/guide-to-free-plans/ or phone 1100 I agree to report a gas leak immediately on 1800 427 532 – 24 hours a day I agree to report electrical problems (eg. stobie pole down, live wire issue, shock/tingle) to 13 13 66, 24/7 . I can check for outages at https://outage.apps.sapowernetworks.com.au/OutageReport/OutageSearch I will ensure site waste is tracked where necessary (eg. asbestos). See: https://www.epa.sa.gov.au/business_and_industry/tracking_and_transporting_waste/fact_sheets/waste_that_must_be_tracked I will report an environmental or pollution incident 24/7 on (08) 8204 2004 I will photograph and review the site evacuation image/map. First Aid or Minor Injury * Location of site First Aid Kit: * Nearest medical facility. Address & Phone: Emergency Response - Dial 000 for ambulance, fire or police Once an emergency call has been made it must be reported to the Site Supervisor as soon as possible if not already. The following authorities may also need to be contacted: Poisons Information Centre: 131 26 EPA Radiation Emergency Response Team: 1800 307 733 Water: WHS: Insurance: Environmental Protection Agency: 8204 2004 Other: Do you agree to report all incidents and near-misses? * Once all emergency calls have been made, incidents must be reported to a representative of the Site Principal Contractor ASAP. Plant & Equipment Operators checked for appropriate license Plant/Equipment checked that within service period Thank you!
