GL-IMS-F-26 1. Host First Contact Checklist
This checklist is to be used by HOST employer
Host Details
Name of host employer
Representative
Email
example@example.com
Company ABN - Check
https://abr.business.gov.au/
Site Address:
Street Address
Street Address Line 2
City
State / Province
Postcode
Type of Business
Completed by:
First Name
Last Name
Date of Assessment:
-
Day
-
Month
Year
Date
Host employer
Structured approach to managing safety
*
Rows
Yes
No
Detail how or if no, what could we do about this?
Is there a system for managing safety?
Is it documented?
Historical OHS performance
*
Rows
Yes
No
Detail how or if no, what could we do about this?
Host employer WorkCover #
Industry premium rate
Host employer premium rate
Host employer’s performance rating
Is Host employer performance rating greater than industry premium (indicates poor OHS management in the past three years).
Organisational size and structure of workforce
*
Rows
Yes
No
Detail how or if no, what could we do about this?
Number of full-time staff?
Number of casual and labour hire staff?
Is there a much greater number of casual and labour hire staff to ongoing staff?
Is there a formal induction process?
Historical claims performance
*
Rows
Yes
No
Detail how or if no, what could we do about this?
Number of injuries in past year?
What percentage of client’s staff is this? Total number of staff divided by the number of injuries X 100 = % of staff injured _____________ ÷ _____________ x 100 = _____________
Will labour hire workers be working in the areas where injuries were mostly sustained?
The work
Job title:
*
Summary of tasks:
*
Plant and equipment to be used:
*
Substances and materials to be used:
*
Hours of work:
*
Intended duration of contract:
*
Supervisor (name, position and contact details):
*
Level of supervision to be provided (tick):
*
Continuous
Frequent2
Occasional
Minimal
Minimal
Other
Minimal
*
Induction
On-the-job
Formal
None
Other
Is protective equipment required? (Host employer to supply)
*
Yes
No
Other
The labour hire worker
Labour hire worker qualifications:
*
Labour hire worker experience:
*
Other selection criteria (medical/literacy/numeracy/licences/permits):
*
The work environment
Physical location of work – address, plant number etc:
*
Who are safety issues reported to? (name, role and contact details)
*
How are safety issues reported? (tick)
*
Verbally
In writing
Other
Is there a safety coordinator?
*
Yes
No
Other
Hazards in the workplace
*
Rows
Yes
No
Detail how or if no, what could we do about this?
Loud noise
Lifting
Electrical
Chemicals
People and vehicles in same areas
Falling objects
Dangerous machinery
Vehicles/plant
Unguarded equipment
Heavy loads
Stretching or reaching
Slippery or cluttered floors
Psychosocial hazards
Are there hazardous substances? (Refer to the OHS Regulations)
Is there hazardous manual handling work? (Refer to the OHS regulations)
Other
Upload SWMS or Safe Operating Procedures (SOP) for the labour hire proposed work
Browse Files
Cancel
of
Who completed the workplace HOST information?
Completed by:
First Name
Last Name
Date:
-
Day
-
Month
Year
Date
Signature of person who completed the form
Submit
Should be Empty: