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Take 5

Complete this simple checklist before starting at a new workplace to make sure the workplace is safe and reduce the risk of getting injured.

Your details
What is your first name?*
What is your surname?*

Your employment details
What is the name of the IntoWork business you are working for?*
What company or organisation are you working at?*

Have you been given a site induction?*
- Yes
- No
- NA
Do you know how to report hazards and incidents?*
- Yes
- No

Has the emergency facilities and evacuation procedure been explained to you?*
- Yes
- No
Are adequate worker facilities provided (toilet, washing, meal area, etc.)?*
- Yes
- No

What hazards are present in the workplace?
- Asbestos
- Biological -bacteria, viruses, etc.
- Chemicals
- Confined spaces
- Electrical
- Environment -heat, cold, wind, etc.
- Equipment operation
- Fire and explosion
- Fumes and vapour
- Machinery
- Manual handling
- Noise
- Poor work design
- Psychological -violence, stress, etc.
- Repetitious work
- Sharp objects
- Slips, trips and falls
- Traffic and vehicles
- Working at height
- Other
Other hazard*

Have you asked the person in charge about the relevant hazards and precautions to take?*
- Yes
- No
- NA

Are there licenses, permits or documented procedures required to do the work (SWMS, JSA, forklift lic. etc)*
- Yes
- No
Do you have the required license, permit or documented procedure to do the work?*
- Yes
- No
- NA

Do you understand what the job is about?*
- Yes
- No
Are you competent to do the work?*
- Yes
- No

Will you be provided adequate instruction and supervision?*
- Yes
- No
- NA
Do you have the necessary safety gear (PPE) for the work?*
- Yes
- No
- NA

How likely would it be to have an injury at the workplace?
- Will rarely happen
- It is unlikely to happen
- It may be possible
- It is likely to happen
- Almost certainly will happen

If an injury happened, how serious could it be?
- Minor first aid at work
- Medical treatment at doctor
- Minor injury with a few days off
- Serious injury and many days off
- Death or permanent disability

Do you believe that you will be working in a safe workplace?*
- Yes
- No
Please tell us what is unsafe

Contact IntoWork:

1300 99 WORK (9675)
192 High Street Northcote, VIC 3070