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OHSEFM_013A

SIME COMPANY INDUCTION - RECORD

FULL NAME: _________________________________________

COMPANY NAME: ____________________________________ POSITION: ______________________________________

MOBILE #: ____________________ POSTAL ADDRESS TO SEND CARD: ______________________________________

Current Certificates and Licences held

Please supply copies of all certificate and licences listed below to ensure compliance with statutory requirements.

Drivers Licence #: ____________________ Expiry Date: ______________ Classes held: _____________________

Blue / White Card #: _____________________________ Card dated: ________________ (Pre-requisite: legal requirement)

Please note: If you have been out of the industry for two years or more you are required to complete Safety Induction refresher

training. Do you require refresher training? If yes, tick box

WorkSafe High Risk Licence #: ______________ Expiry Date: ___________ Classes held: ____________________

Trade Certificate - details: _______________________________________ Date obtained: ____________________

Electrical Contractor (EC) / Worker (EW) Licence #: ________________ Expiry date: _______________________

List any conditions or restrictions: __________________________________________________________________________

Plumbing Contractor Licence #: _______________________________ Expiry date: _______________________

List any conditions or restrictions: __________________________________________________________________________

Tradesperson’s (Drainage Plumbing) Licence #: _____________________ Expiry date: _______________________

List any conditions or restrictions: __________________________________________________________________________

Gas Fitter Licence #: _____________________ Class (ie. G or I): ________ Expiry date: ______________________

List any conditions or restrictions: __________________________________________________________________________

Refrigeration Licence #: ____________ Class: RAC SPLIT DOM AUTO Expiry date: ____________

List any conditions or restrictions: __________________________________________________________________________

Senior First Aid Certificate Expiry date: ________________

Any certificate and/or licences held but not listed above, please list here (eg. Working at Height, Confined Space etc.):

____________________________________________________________________________________________________

____________________________________________________________________________________________________

DECLARATION

I confirm I have completed a Sime Company Induction - Questionnaire OHSEFM_013A on the date listed below.

INDUCTEE’S SIGNATURE: __________________________________________________ DATE: ___________________

OFFICE USE ONLY

INDUCTION CARRIED OUT BY: ______________________________________________

SIGNATURE: ______________________________________________________________ DATE: ___________________

DOB (optional): __________________

OHSEFM_013A

SIME COMPANY INDUCTION - QUESTIONNAIRE

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Induction Questions

1. What is the Employer’s duty of care as detailed in section 19 of Occupational Safety andHealth Act 1984?

a. Provide and maintain a safe workplace and plant.

b. Provide a safe system of work.

c. Provide information, instruction and training.

d. Provide PPE as required.

e. Provide safe access and egress to work areas.

f. All of the above.

2. What is the Employee’s duty of care as detailed in section 20 of Occupational Safety andHealth Act 1984?

a. Take reasonable care of your own safety and health.

b. Avoid harming the safety and health of other people.

c. Follow employer’s safety instruction and wear PPE as provided.

d. Report all injury, disease and hazards.

e. Take good care of equipment.

f. All of the above.

3. What are the minimum requirements to commence work on a Sime construction site?

a. Completed Blue Card or White Card.

b. Completed a Sime Induction.

c. Wearing the correct PPE.

d. Be in a fit state for work.

e. Completed a Sime Site Specific Induction.

f. All of the above.

Induction Questionnaire instructions:

This questionnaire forms part of the Sime Company Induction to determine your (the Inductees)

underpinning knowledge of safety and health responsibilities and the requirements to work on Sime

construction sites.

In the multiple choice questions there is only one correct answer so read each answer carefully prior

to marking the correct answer.

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SIME COMPANY INDUCTION - QUESTIONNAIRE

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4. What are the minimum PPE requirements to work on a Sime construction site?

a.

b.

c.

d.

Hard hat, safety glasses and steel capped boots.

Hard hat, safety glasses, steel capped boots, hi visibility vest and long sleeve shirt.

Hard hat, safety glasses, steel capped boots and short sleeved shirt.

Hard hat, steel capped boots and hi visibility vest.

5. What daily paperwork must be completed prior to starting work onsite?

a. Sign in on the Day Register.

b. Daily pre-start checklist.

c. Any permits that may be required.

d. Take 5 or JSA (depending on the task).

e. All of the above.

6. List four steps that can prevent sunburn and heat stress:

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

4. ________________________________________________________________

7. What is the permissible blood alcohol reading to work on a Sime construction site?

a. 0.0.

b. 0.8.

c. 0.5.

8. When should you report an accident / incident?

a. When requiring attention from a doctor.

b. All accidents and incidents must be reported.

c. If it becomes a lost time accident.

d. If requiring first aid.

9. What is the correct lifting posture?

a. Hold your breath and use your back to lift carefully.

b. Keep your back straight and bend your knees.

c. Keep your legs straight and bend your back.

10. When using cranes onsite, what are the safety requirements?

a. ________________________________________________________________

b. ________________________________________________________________

c. ________________________________________________________________

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11. What is the sound of the evacuation signal?

a. Siren.

b. Air Horn.

c. Bell.

12. When should a Material Safety Data Sheet (MSDS) be onsite and filed in the site office?

a. Only when a product is being used on site.

b. Prior to all products being brought on to site.

c. Only if the chemical is to be used in large quantities.

13. What information does an MSDS contain?

a. Chemical makeup of the product.

b. PPE to be used when handling the product.

c. How to contain and neutralize any spills.

d. First aid procedure should you come in contact with product.

e. All of the above.

14. Prior to portable electrical equipment (drills, grinders, cords etc) being brought onto site whatare the two requirements?

1. ________________________________________________________________

2. ________________________________________________________________

15. All portable electrical power tools are required to be run from what source?

a. Main switchboard with a fixed RCD.

b. Portable RCD.

c. All of the above.

16. When using extension leads onsite what are the requirements?

a. Must be protected from mechanical and accidental damage by either of the following; by insulated stands or other protection methods if more than five meters from work area.

b. Maximum length of extension cord - 30m.

c. No joining of extension cords.

d. Must be fitted into the switchboard through the opening in the bottom, not through the switchboard door opening.

e. All of the above.

17. Who is required to attend site toolbox meetings?

a. Only if you have time.

b. All persons onsite at the time a meeting is coordinated.

c. One representative from each company working onsite at time of meeting.

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SIME COMPANY INDUCTION - QUESTIONNAIRE

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18. When is a Hot Work Permit required?

a. When flammable substances are present in hot work area.

b. Only if oxy equipment is used.

c. Only if a welder is used.

d. All work that requires use of oxy equipment, welders or grinders.

19. When is a Confined Space Permit required?

a. In areas that are less than 1m in height.

b. In areas with limited access and egress.

c. In a trench.

20. When is a Working at Height Permit required?

a. Above 4m.

b. Above 2m.

c. Tasks that require working at any heights where the possibility of falling is present.

21. When is an Excavation Permit required?

a. Excavation deeper than 300 mm.

b. Excavation deeper than 600 mm.

c. All excavation.

22. Out of Service tags are what colour and what do they protect?

a. Red and white, with black writing – protects your personal safety.

b. Yellow with black writing – protects machinery only.

c. Red with black writing – protects you and machinery.

23. Danger tags are what colour and what do they protect?

a. Red and white, with black writing – protects your personal safety.

b. Yellow with black writing – protects machinery only.

c. Red with black writing – protects you and machinery.

24. What height does scaffolding require a top rail, mid rail and toe board?

a. 1200 mm.

b. 2000 mm.

c. 4000 mm.

25. What are acceptable working platforms?

a. Safe step platforms and scaffold trestles with SWL.

b. Milk crates and small drums.

c. Home-made stands and trestles.

d. Ladders.

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26. Where is the first aid cabinet located?

___________________________________________________________________________

27. Where are the muster points located on site and how can you identify them?

___________________________________________________________________________

28. What consideration should be given for dust and noise control?

a. Sprinklers prior to commencing earthworks and trenching.

b.

c.

d.

Carry out noisy tasks toward the centre of the site if possible to reduce the impact on

neighbours.

Plan to complete noisy tasks between 7:00am and 5:00pm.

All of the above.

29. If trees or vegetation are required to be removed from site, what procedure should befollowed?

a. Contractor to make the decision.

b. Sime management to make the decision.

c. Sime management to make the decision after consultation with the client.

30. List three hazards common to your trade?

1. _______________________________________________________________

2. _______________________________________________________________

3. _______________________________________________________________

31. What are the three main points for writing a JSA?

1. _______________________________________________________________

2. _______________________________________________________________

3. _______________________________________________________________

32. Which option below accurately lists the HIRAC of controls, in most effective to least effectiveorder?

a. Elimination, substitution, isolation, engineering, administration, PPE.

b. Elimination, isolation, engineering, substitution, PPE, administration.

c. PPE, administration, engineering, isolation, substitution, elimination.

33. When do you need to complete a Take 5?

a. For all high risk tasks.

b. For all tasks not listed as high risk.

c. Only for medium risk tasks.

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34. What is required when working with powered mobile plant?

a. JSA.

b. Permit from Site Supervisor.

c. Permission from the plant operator.

35. What high risk work is common on Sime sites?

a. Working at 2m or more.

b. Excavation to a depth of 1.5m.

c. Working with or near powered mobile plant.

d. All of the above.

36. What are specific requirements for working on school projects?

a. No swearing.

b. No smoking.

c. No bare chests.

d. No loud music.

e. All of the above.

You have reached the end of the Sime Company Induction Questionnaire!

Induction Checklist (please tick checkboxes below)

□ Induction Record is completed and signed (page 1)

□ Induction Questionnaire completed

□ Copies of Training Certificates and Licences are attached.

Please save/print a copy for your records by clicking the 'save' or 'print' button below.

RETURN VIA EMAIL: Please click the 'submit' button below to submit a copy of your completed Induction to Sime via email. (Please attach copies of your training records to this email.)

RETURN VIA FAX/POST: Don't have email access? Please print and fax or post a copy of your completed Induction along with training records to:Fax: 08 9072 1999Post: Sime Building and Construction, PO Box 1870 Esperance WA 6450