SAFETY INDUCTION

Please read the Safety Induction PDF,
then complete and submit the Safety Induction form below.

    Relationship to Workplace/Project/Site



    PERSONAL DETAILS
    Interpreter required?



    Date of Birth



    Next of Kin/Emergency Contact


    Medications/Allergies
    Do you have any allergies or are you taking any medications which may require specific medical treatment or medication in the event of a medical incident?

    Personal Protective Equipment
    Required PPE (Always)

    Additional PPE (If Applicable)

    White Card or Equivalent


    Issue Date

    SWMS / Permits supplied: (Safe Work Methods)


    Issue Date




    Expiry Date

    Medical Information
    Do you have any existing restrictions / problems / injuries / allergies, that will impede you while carrying out tasks incorporating the following?

    Safety and Environmental Induction Acknowledgment

    • I have completed (company name)’s Site Specific Safety Induction and I will comply with all relevant and current health and safety standards, legislation, rules, requirements and any reasonable Health and Safety Instructions given to me by the workplace/site management and/or representatives.

    • I am aware of and will comply with Health and Safety requirements in relation to all aspects of the work that I am to carry out at SRS Power workplaces/sites and I will conduct a risk assessment before carrying out any task and I will request, provide and/or use all necessary PPE, plant, tools and equipment and utilise/implement all correct and compliant work procedures required to carry out the work in a safe manner.

    • I am aware of my insurance requirements, and I am sufficiently covered for Public Liability and work cover.

    • I confirm that I have received the SRS induction and I understand the safety and emergency protocols outlined during the induction.

    • I certify the above information is true and correct and any pre-existing injury or illness that could be aggravated and/or put me at risk of injury and/or preclude me from carrying out the work that I have been employed to undertake has been disclosed.

    Inductee Signature

    Please answer