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* Indicates Required Fields

Name *       Company/Org    

Phone  *       Email*    
   
State*        Please Select Victoria New South Wales Queensland South Australia A.C.T. Northern Territory Western Aust Tasmania     Number of Employees    Please Select Less Than 20 20 - 50 50 - 100 100 - 200 200 or more


Special Note: Please answer every question to allow us to complete your free report more effectively.

Leadership & Commitment

a. Do you have a health and safety policy authorised by the organisation’s current Chief Executive, or appropriate other person with executive responsibility ?
  Select One Yes No Partially Complete Not Applicable

Workplace Arrangements

b. Are there Designated Workgroups in place ?
  Select One Yes No Partially Complete Not Applicable

c. Does your organisation obtain health and safety advice from competent persons (in-house or external) ?
  Select One Yes No Partially Complete Not Applicable

d. Have specific responsibilities imposed by health and safety legislation have been identified and allocated to individuals within the organisation ?
  Select One Yes No Partially Complete Not Applicable

e. Do you have a Workplace Health and Safety Committee which meets and minutes its meetings ?
  Select One Yes No Partially Complete Not Applicable

f. Are employees involved and consulted on health and safety issues and disputes as they arise ?
  Select One Yes No Partially Complete Not Applicable

g. Is Health and Safety Promoted as a part of procedures and work instructions ?
  Select One Yes No Partially Complete Not Applicable

h. Do all your facilities and amenities in the workplace conform to relevant legislation, standards and codes of practice ?
  Select One Yes No Partially Complete Not Applicable

Contractors & Contract Controls

i. Are contractors and third parties advised of their safety obligations to employees and safety systems while on your premises ?
  Select One Yes No Partially Complete Not Applicable

j. When supplying products or services under contract, are adequate procedures in place to ensure the safety of your employees and the public outside your premises ?
  Select One Yes No Partially Complete Not Applicable

k. Do your staff and all your contractors maintain current certificates to perform work where required ?
  Select One Yes No Partially Complete Not Applicable

Procurement

l. When purchasing goods and services, are you able to demonstrate that technical data and other information relevant to health and safety are examined prior to any decision to purchase ?
  Select One Yes No Partially Complete Not Applicable

Risk Management

m. Does the organisation have a risk management system in place, including the identification and reporting of workplace hazards, assessment and control of risk plus a monitoring and review mechanism ?
  Select One Yes No Partially Complete Not Applicable

n. Does the organisation have an Emergency, Disaster and Fire Control Plan ?
  Select One Yes No Partially Complete Not Applicable

o. Can you demonstrate that you have a policy relating to the provision of first aid and refreshers ?
  Select One Yes No Partially Complete Not Applicable

Training & Supervision

p. Are Safe Working Procedures (SWPs) in place, including job descriptions or duty statements ?
  Select One Yes No Partially Complete Not Applicable

Do training procedures, work instructions and preventative measures and records exist for;

Incident Reporting & Investigation

v. Do procedures exists for reporting health and safety hazards and are employees aware of their existence ?
  Select One Yes No Partially Complete Not Applicable

w. Is there a procedure for the investigation of injuries, illnesses and incident ?
  Select One Yes No Partially Complete Not Applicable


Other Notes & Specific Needs