Site Health & Safety Induction Form

To be used for Fletcher Construction employees and Subcontractor representatives

Name:

Position: Mobile Phone Number:

Employer/Company: Inducted By:

Site Safe Passport #:

Expiry Date:
10. Site Amenities
1. Fletcher Construction Company Health and Safety Policy > What and where (toilets, wash areas, smoko sheds, etc),
> Read and discuss (if not done previously). and any restrictions.
2. Site Safety Plan and Site Access/Egress 11. Emergency Procedures
> Overview all aspects of Site Safety Plan and method(s) of > Review Emergency Procedures, including evacuation notice,
site access and egress. assembly point, nearest Emergency Medical Centre.
3. Housekeeping 12. Accident and Incident Reporting
> Importance of housekeeping in minimisation of hazards > Review Accident and Incident Reporting procedures,
and in maintaining a clean and tidy work environment. including near misses and where Register is kept.
4. Site Hazards and their Identification and Control 13. Conduct and Discipline
> Review documented Site Hazards (Register) and > Overview expected conduct and rules relating to breach of
overview how to identify and eliminate, isolate or minimise conduct (referring to the Employment Contract).
hazards likely to be created or encountered. Overview > Drug and Alcohol Policy
process of notification of new hazards introduced. > Smoking Policy
> Task analysis > Code of safe conduct
5. Personal Safety and Safety of Others 14. Safety Equipment
> Overview importance and statutory responsibility (both > What is available and where (including First Aid Kits, Fire
Employer and Employee) of Personal Safety. Extinguishers, etc).
6. Safety Information 15. Training in Inspection and use of Equipment
> What and where kept (including Material Safety Data > Confirm employee is adequately trained in the inspection
Sheets and other relative information). prior to use and safe operation of all plant, equipment and
personal protective equipment they may use while on site,
including verification of qualifications.
> NZQA Harness and I5757 Training Requirements
7. Personal Protective Equipment (PPE) 16. Fletcher Site Specific Policies and Procedures
> Safety Hard Hat; > Glasses and Gloves Policy;
> Safety Footwear; > Mobile Scaffolding Policy;
> Hi Visibility Vest/Jacket; > Grinder Policy;
> Safety Glasses & Gloves > Working at Heights Checklist;
> Other: ____________________________________ > Restricted use of ladders;
> Other equipment will be provided where the hazard > Hot Works Permit System;
exists. All subcontractors are to provide their own PPE. > Electrical Isolation Permit to Work.
8. Health and Safety Meetings, Monitoring and Audits 17. Safety Principles
> When and who will be involved. > Review Fletcher’s 5 Safety Principles
9. Identify appointed Fletcher Construction Safety
Representative and First Aid personnel
> Who and where to find them.

18. List any impairment, incapacity, handicap or disability that could affect performance of duties, or has the potential to put
self or others at risk. (Including any special treatment, medication etc required).

19. Other specific requirements not listed above:

If you are unsure about using any equipment or performing any task, DO NOT PROCEED! Seek help from Fletcher’s Site Representative
I acknowledge I have reviewed and understood all items on this Site Health & Safety Induction Form and I am aware of
my responsibilities and continuing obligations.

Name Signature Date

_______________________________ ___________________________ ______________________

Issue Date: July 2013 Revision Date: July 2014 The Fletcher Construction Company Limited Health & Safety Manual HSM DOCUMENT 09
Document Owner: National Health & Safety Manager. Version 1.