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Incident Report

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Site Induction
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Incident Report

Site Induction Form

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This field is for validation purposes and should be left unchanged.

Before you begin the Site Induction, please read our Work Health & Safety Plan. This can be found in the Sub-Contractor Portal of our website.

I have read and understand the CBS Work Health & Safety Plan (WHS)*

Yes

No

Name*

First Name Last Name

Email*

Date of birth*

DD slash MM slash YYYY

Mobile*

Next of Kin Contact

Relationship

Their Contact No.

Employer*

Trade*

Supervisor

Any medication, allergies or illness to be declared (if none, state no)*

Are you on any return to work or rehabilitation plan? Detail if yes.

White Card No.:*

Issue Date:*

DD slash MM slash YYYY

Certificates

Please add the type of certificate you have along with its number in the columns below. Click the + button to add more. Examples include: First Aid, Dogging or Rigging, Electrician, Elevated Work Platform, Gas Fitter, Plant Operator, Scaffolder, Safe Work At Height...

Certificate

Certificate Number

Site Induction Questionnaire

Workplace Safety is the responsibility of*

Project Manager

The Site Manager

The Safety Committee

The Employees/ Sub-contractors

All of the above

Hazard Reporting - If you identify a hazard that you cannot fix, who should you contact first?*

The Site Manager

Leave it for the next person

Your work mate

Personal and Protective Equipment - Which of the following items must be worn at all times while working on this site?*

Hi-Viz workwear

Safety footwear

Safety glasses (medium impact)

All of the above

If there is an incident and or you are injured at work, do you need to report it to a Company Site Manager before leaving the construction site?*

Yes

No

I can find the Incident Report Template in the*

Subcontractors' User portal in Custom Build Solutions' website

File on site "Work Health & Safety Management Plan"

All of the above

Working at Height - Prior to using a Mobile Elevated Work Platform (MEWP) what must be done?*

Have a competency assessment or ticket for the use of MEWP

Perform a safety check and complete logbook provided with the machine

Check the work area is clear and free from hazards such as timber, leads on ground, level changed in pathway etc

Ensure a harness is worn and connected when using a boom type EWP

All of the above

Risk Assessment - What is the MOST PREFERRED method in the risk hierarchy of control to prevent injury or illness?*

Substitution

PPE

Elimination

Administrative

Engineering

Excavations - What must you do when excavating a trench deeper than 1.5 metres?*

Bench with bench height no higher than it is wide, batter at an angle no more than 45 degrees or shore with approved boxing for the trench depth.

Have a competent person inspect the trench prior to entry

Barricade and affix hazard warning signage if the trench is left unattended

All of the above

Electrical - What should you check before plugging-in an electrical tool on site?*

The power tools lead has not been damaged

The extension lead has not been damaged

Tools and leads have a current safety test tag

The RCD on the switch panel

All the above

Housekeeping - A clean site is a safe site. When should you clean-up?*

Continuously during the task to maintain safe access and egress and to eliminate slip, trip and fall hazards at the workplace

At the end of the day

At the end of the week

Induction carried out by*

My Supervisor

Scott Maloney

Consent*

I understand the requirements of the site induction and agree to comply with company requirements at this site.

Name*

First Name Last Name

Date:*

DD slash MM slash YYYY

Contact

For more information or technical support please contact the Custom Build Solutions team.

We’re available Monday to Friday, from 8 am – 4:30 pm (except on public holidays).

P: 1300 817 779
E: scott@custombuildsolutions.com.au

If you have any safety queries or concerns, please contact info@custombuildsolutions.com.au.

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