Health & Safety Agreement

Health & Safety Agreement
The following is your personal acknowledgement.

The collection, use, and storage of personal information will be in accordance with the Privacy Act 2020.

CLW Health & Safety policy
Are you an employee or volunteer?

EmployeeVolunteer
Health & Safety

I have a clear understanding of the following:*

	Agree	Disagree
2. The evacuation procedure (see Health and Safety policy and noticeboard).
4. The CLW lockdown procedure
5. The first aid kit located in the kitchen.
Responsibilities of workers (see Health and Safety Policy)
6. The assembly area is outside Smith and Smith Glass on Anglesea Street.
7. All hazards and controls relevant to the worker's role have been explained.
1. I have read the Health and Safety policy and understand and accept my responsibilities.
I have been informed who the Health & Safety officers, and First Aiders are?

I know how to report:*

	Agree	Disagree
Injuries/harm, Property damage etc.
Property Damage
Near misses

Signature*

Clear
Name

By submitting this form, I confirm that I have read, understood and accept the terms above.
Email*
A copy of this form will be emailed to you
Should be Empty: