Employee/Contractor Induction Form

INDUCTION FORM

EMPLOYEE/CONTRACTOR
January 2024 Upd.02

Form no. EG-PRO-0007-04
Name of person completing induction form:

First NameLast Name
Name of Company:
Company name of person completing induction form.
Email Address:
example@example.com
Mobile Number:

Area CodePhone Number
Reason for completing induction form:
Reason for completing induction form.
Who at Egoli gas are you meeting:
Name of person your meeting is scheduled with.
When will you be visiting Egoli gas:

MonthDayYear
DateHourMinutesAM/PM Option
1) What is the procedure to remember during an emergency?*

Stop, Evaluate, Prepare, Then ProceedStop, Think, Ask Someone, Then ActStop, Think, Turnaround, Then RunNone of the above
2) What is considered as an emergency?*

Gas leaks and fireBomb threat and riotsNatural disastersAll the above
3) Who is responsible for the health and safety of people at work?*

Top ManagementSupervisorsEmployeesAll of the above
4) Which of the following is NOT part of our Life Saving Protocols?*

IntegritySafetyPoor performanceAll the above
5) Who is responsible for conducting Risk Assessments?*

Team LeaderSupervisorCompetent PersonSHEQ Officer
6) Why must correct barricading be ensured?*

For safetyTo allow for pedestriansTo prevent accidentsAll of the above
7) You may smoke anywhere you want on Egoli Gas premises?*

TrueFalseNot sureNone of the above
8) What option below is not part of the 3-point contact rule?*

Keep one foot groundedKeep both hands-on the handrailKeep your eyes on the pathKeep one hand on the handrail
9) Which of the following jobs require a permit to work?*

Working on live gasConfined spaceWorking at heightAll the above
10) When must incidents be reported?*

Immediately or before end of shiftThe following dayBefore 7 days or end of weekNone of the above
11) To whom must you report unsafe behavior or conditions?*

Maintenance departmentHR departmentSHEQ departmentManaging Director
12) What is good housekeeping?*

Everything in its place – alwaysCleaning work areas once a monthPicking up cigarette ends weeklyWashing PPE and vehicles every 2 weeks
13) What is the acceptable speed when driving in Egoli Gas premises?*

20Kph40Kph50Kph60Kph
14) Who is allowed to talk to the media in the event of a catastrophic incident?*

The SHEQ OfficerThe HR ManagerThe person appointed by the MDThe Sales Manager
15) Which of the following is our goal according to the SHEQ policy?*

Zero harmTake inappropriate actionsDemonstrate FairnessNone of the above
16) What actions are taken in our operations?*

Ensure operations are safe and reliableIgnore unsafe actionsNone of the aboveAll of the above
Signature:

Clear
Should be Empty:

INDUCTION FORM

January 2024 Upd.02