ContractorPRESTARTRA

Job No *

Site Address *

Supervisor Name *

Supervisor Email *

Enter Supervisors email to receive a copy.

Contractor/Company Name *

Email *

Enter your email to receive a copy

Briefly describe works to be carried out? *

Such as Site cut, Plumbing, Slab, Framing, Fascia & Gutter, Roofing, Electrical. etc.

SITE INDUCTION & SAFE WORK METHOD STATEMENTS

Have you been site inducted? either spoken to the Site Supervisor via phone, in person or emailed to discussed any site specific hazards? *

Yes
No
Not Applicable

It is your responsibility to contact the Supervisor if this has not happened.

What method of contact has been used for your site induction? *

Phone
In person
Via email

State why you have selected No. *

It is your responsibility to contact the Supervisor if this has not happened.

State why you have selected Not Applicable. *

Entry to any Perry Homes sites must be authorized by the person in charge of the site (Supervisor)

Do you require a SWMS for high risk works? *

Yes
No
Not Applicable

SWMS must be site specific and must be prepared for all high risk work.
There are 18 categories of high risk works, check yes to see this list if unsure.

Select which High Risk Works you will be doing. *

Do you have a SWMS relevant to this work? (if not, do not start work until you have one. If it does not fully cover the work, amend it so that is does. The SWMS must be on site with you & be available upon request. *

Yes
No
Not Applicable

SWMS must be site specific and must be prepared for all high risk work.

Have all your workers read, understood and signed the SWMS? *

Yes
No

Are there any other hazards not covered in the SWMS? If so, complete the below hazard section. *

Yes
No

Are there hazards currently on site that you need to address prior to starting work? *

Yes
No

Hazard # 1 *

What needs to be done to control this hazard # 1 *

Are there addition hazards? *

Yes
No

Hazard # 2 *

What needs to be done to control this hazard # 2 *

Are there addition hazards? *

Yes
No

Hazard # 3 *

What needs to be done to control this hazard # 3 *

SITE CONDITIONS

Have you read and understood the Perry Homes Safety Management Plan? Readily accessible via this website. *

Yes
Not Applicable

You must select yes for this, if you have not, you must do so prior to starting work and except the requirements.
Click the link below to select the applicable supervisors job to view content:
https://www.phasafety.com/safetymanagementplans/

Do all your workers have their Safety Construction Induction Card details with them at all times? *

Yes
No

Is access to the site suitable for work to be carried out? *

Yes
No

Are the toilets fit for use and reasonably clean? If not contact the site supervisor to have this rectified. *

Yes
No

TOOLS AND EQUIPMENT

Are you required to work above ground/slab level? *

Yes
No

What method will you be using to work above ground level? *

Trestles & Planks
Scaffolding
Step Ladder / Extension Ladder
Other

Specify Other *

What other means will you be using?

Has the appropriate fall protection been installed? (No working over 2 meters without fall protection.) *

Yes
No
No work over 2m
Not Applicable

Are your ladders commercially rated for the specific task & in good condition? *

Yes
No

Must have 3 points of contact at all times.

Do you have sufficient planks to complete the task? Note: working platform must be a minimum 450mm wide. *

Yes
No

Will there be electrical equipment used on site? *

Yes
No

Are workers using the electrical equipment been properly trained in their use? *

Yes
No

Is your electrical equipment in good condition, tested and tagged within the last 3 months? If not must be removed from site. *

Yes
No

Are all guards fitted and in good condition? (Power tools are not to be used without guards.) *

Yes
No

Do your workers have and use the appropriate safety equipment? (Personal Protective Equipment and UV protection safeguards.) *

Yes
No
Not Applicable

Such as Hearing, Eye, Gloves, Hard Hat etc.

Contractors Name *

Signature *

Clear Signature

Date *