Sign On/Off & Daily Safety Induction
LVR F 025 Version 10.0 Review 25/05/2021
Safety Briefing for Operations on Date:
*
/
Day
/
Month
Year
Today's Date
Worker/Volunteer Name
*
First Name
Last Name
Worker/Volunteer Email Address
*
example@example.com
Rostered Position on Train
*
Please Select
Locomotive Driver
Locomotive Driver Trainer
Locomotive Second Person/Fireman
Guard
Passenger Attendant
Train Manager
Maintenance Support Person
Boiler Attendant
Shunter
Track Vehicle Operator
Location
*
Please Select
Locomotive Driver
Locomotive Driver Trainer
Locomotive Second Person/Fireman
Guard
Passenger Attendant
Train Manager
Maintenance Support Person
Boiler Attendant
Shunter
Track Vehicle Operator
Rostered Sign On/Sign Off Time
*
Hour Minutes
Until
until
Hour Minutes
Total 0.0
Actual Sign On Time
*
Hour Minutes
By acknowledging the following items, I attest:
*
Rows
I Attest
that I am in possession of a safety vest
that I am wearing suitable Personal Protective Equipment (PPE)
that I am carrying my CoC Card and other required identification cards ie. High Risk Work Licence Card, Responsible Service of Alcohol Card & Working With Children Card.
that I possess the relevant qualifications for the position I am rostered for
that I have read a copy of the safety critical documention, if applicable
that I have read and understood LVOP's applicable to the position I am rostered for
that I will obey all instructions given by the Operations Safety Officer of the day
that I am aware of the conditions set out in the Rail Safety Act with respect to Fatigue Management
that I have read and understood the LVR Fatigue Policy and am fit for duty as per that policy
that I have read and understood LVR Drug & Alcohol Policy and am fit for duty as per that policy
Signature
*
Location
Submit
Should be Empty: