PC Induction Form
Stage
Operative Details
Please complete the details below on behalf of the operative you wish to request for induction.
Full Name:
*
Mobile Number:
*
Email:
*
example@example.com
Company Name:
*
Job Role:
*
Please Select
Area Manager
Back-Up Driver
Camera Operator
Gas Safe Trainee
Grab Driver
Grab Driver's Mate
Team Leader
NCO (Gas) Assistant
NCO (Gas) Service Layer
NCO (Gas) Main Layer Up to 180mm
NCO (Gas) Main Layer Up to 180mm & Service Layer
NCO (Gas) Main Layer Up to 355mm
NCO (Gas) Main Layer Up to 355mm & Service Layer
NCO (Gas) Main Layer above 400mm
NCO (Gas) Main Layer above 400mm & Service Layer
NCO (Gas) Trainee
Site Manager
Supervisor
Contracts Manager
Operations Manager
Project Manager
Quality Advisor
Reinstatement Operative
Reinstatement Team Leader
Reinstatement Project Manager
Reinstatement Contracts Manager
Reinstatement Site Manager
HSEQ
Vac Ex Driver
Other
Please State Job role:
*
Choose Date and Induction Time:
Training & Competency
To ensure a safe working environment, information is collected to confirm that the operatives have the appropriate training, qualifications, and experience to carry out their role safely.
EUSR Number (If Applicable):
Please upload training certificates and cards relevant to the job role:
*
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Respiratory Protective Equipment (RPE) & Face Fit
Operatives required to use respiratory protective equipment or breathing apparatus must provide valid competency and face fit certification prior to commencing works.
Does the role require an RPE Face Mask?
*
Yes
No
Please upload RPE Face Fit certificate:
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Does the role require a breathing apparatus?
*
Yes
No
Please upload BA Face Fit certificate:
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Additional Details from Operative
Please complete the details below.
Date of Birth:
*
-
Day
-
Month
Year
Gender:
*
Please Select
Male
Female
Other
Please state your gender:
Address:
*
Emergency Contact Name:
*
Emergency Contact Relation:
*
Emergency Contact Mobile Number:
*
Health Questionnaire
To ensure a safe working environment, this information is collected to identify any health conditions that may affect your ability to work safely on site.
Are you fit to carry out your role safely on site?
*
Yes
No
Do you have any medical condition that could affect your ability to work safely? (e.g. epilepsy, diabetes, heart conditions, severe asthma, vertigo)
Yes
No
Please provide brief details:
*
Are you currently taking any medication that may affect your alertness, coordination, or ability to work safely?
Yes
No
Please provide brief details:
Do you have any injuries or physical conditions that may restrict your work activities? (e.g. lifting, bending, confined spaces)
Yes
No
Please provide brief details:
Do you have any allergies or medical conditions we should be aware of in an emergency? (e.g. anaphylaxis, asthma requiring inhaler)
Yes
No
Please provide brief details:
*
Drugs & Alcohol
To ensure a safe working environment, all operatives must be fit for work and free from the effects of drugs or alcohol while on site.
Are you fit for work and free from the effects of drugs or alcohol?
Yes
No
Are you willing to undergo drug and alcohol testing if required?
Yes
No
I confirm that:
*
The information is accurate to the best of my knowledge
I will inform my employer if my health status changes
I understand this information is used to ensure my safety onsite
Signature
*
Submit
Should be Empty: