Date of Birth
Emergency Contact Name
Emergency Contact Number
Please click the most appropriate answer
Q 1. Who is the primary person responsible for your safety onsite?
Me WorkSafe Victoria Nobody
Q 2. Do all chemicals and hazardous substances used or stored on site require a Material Safety Data Sheet?
Yes No Maybe
Q 3. Do all electrical appliances and leads require tag and testing?
Q 4. Must you report all injuries, incidents or near misses?
Yes, you must report all incidents, injuries and near misses to the ASBA
Only the serious ones
Q 5. In the event of an emergency what should you do?
Ensure that the emergency services are contacted
Assist persons away from hazardous area if safe to do so
Remain calm and assist where possible
Obey instructions from emergency services, safety wardens, security, first aiders, and management
All of the above
Q 6. When should you operate a vehicle or machine whilst onsite?
Only when properly trained and where required hold a certification or qualification to operate the vehicle or machinery
Q 7. Are you permitted to work under the influence of alcohol or illegal drugs?
Q 8. Are you required to wear high visibility clothing during bump-in / bump-out?
No Yes Only if safety officers are around
Q 9. Are all staff, contractors, and stakeholders required to complete a safety induction for this site?
Q 10. When driving onsite, what precautions should be taken to prevent an incident?
Beware of pedestrians, plant, livestock, and other vehicles
Never block roads or access doors onsite
Secure loads, and observe the speed limits onsite. Note: Walking pace or less than10kph for forklifts trucks.
All of the above
To help eliminate spammers, please type the following code in the box below AKK4AA