Safety - Subcontractor

Job Number Technician Name Tech Phone Number (if a new phone number)

This work involves the following High Risk works:

Working at Heights Greater Than 2m

Electrical Hazard has Been Identified

Asbestos Containing Materials (ACM) are present

Other (if so, please list below)

None

If there any works to be performed where a fall of 2 meters or greater is possible:

The following checks have been completed: (i) Works & Drop zones barricaded from Public, or Compliant perimeter fence/rails in place, (ii) Fall Arrest Harness & anchor points suitable, (iii) Rescue Plan in place, (iv) Roof surface dry and free from trip/slip hazards, (v) Access ladder secure, suitable, on level surface.

List any High Risk works not selected above, or any additional site specific potential hazards not contained within the selected SWMS: If there are any High Risk works or any additional site specific hazards, please outline for each task (i) What are the tasks involved? (ii) What are the hazards and risks? (iii) Risk ranking before controls? (iv) What are the control measures? (v) Risk rankings after controls?

I have completed each of the following (please tick all before proceeding):

SWMS(s) Reviewed

PPE Suitable (if required) – includes high visibility clothing, protective clothing and protection for the following: feet, hearing, head, eyes, face, hands & breathing.

Licences Current – White Card, Working Safely At Heights, Asbestos Awareness

Roof Permit (if required)

Hot Works Permit (if required)

Valid Public Liability Insurance to $20m in place

Workers Compensation Insurance in place

Subcontractors Statement Regarding Worker’s Compensation, Payroll Tax and Remuneration is completed and sent to Nu Life

Sign-Off Note: By submitting this form you agree that this document and accompanying SWMS has been developed in consultation with you and has been read, understood and signed by all workers undertaking the scope of works. You give Nu Life Pty Ltd the right to attach your electronic signature to this document in order to make it legally binding. You also agree that you will be doing the work at the specified job number address, as previously advised, and will be starting the work on the date and approximate time of submission.

02 9549 0000

Technician Safety Submission

This form is to be completed by every working technician.

Thanks for keeping it safe, ya legends!!!