Induction Form » Centrals

Position Title (Operator, Labour Hire, etc) *

Labour Hire Agency or Company Name *

Given Name *

Surname *

Postal Address *

Residential Address *

Date of Birth *

Mobile Number *

Email Address *

Current Weight (Plant Operator Only)

Do you identify yourself as of Aboriginal or Torres Straight Islander Descent?

YesNo

Start/Available Date *

Site Working (If Known)

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Address *

Emergency Contact Phone *

Licence and Qualification Details

Drivers Licence

Drivers Licence Number *

Licence Type / Class *

Drivers Licence Expiry *

Construction Card

Construction Card Number

Issue Date

State

Other Qualifications

Medical Advice

Please state if you have any medical conditions (i.e Epilepsy, Diabetes, Cardiac, Asthma etc). Your answer

Allergies (i.e. medications, stings, foods etc.) Please state allergy and reaction. Your answer

Are you taking any regular medications? If so, please list.

Declaration

Please tick the below boxes: *

I solemnly declare that each and every answer above is true to the best of my knowledge and belief.
I understand that any false or misleading information at any stage of the application process may result in termination of employment.
I understand that my personal details and induction test results will be recorded and stored by Centrals.

Full Name *

Declaration Date *

Induction

Please watch the following induction video and then answer the subsequent test questions.

The test questions will be based on the material contained in the video.

Please tick the below box: *

I declare that I have watched the induction video above and wish to take the test.

Assessment Questions

The questions on this page relate to Centrals CEM Form: F-17-02 Corporate Induction Assessment.
All fields must be completed in order for your induction assessment to be valid.

Project No. and Name

Statement of Commitment

NEVER: Remove, bypass or modify a safety protection device without authorisation.
NEVER: Approach or work in the vicinity of mobile / moving plant (without consultation and risk awareness).
NEVER: Work on equipment without following the correct isolation process.
NEVER: Operate or modify equipment unless competent and authorised to do so.
NEVER: Use lifting equipment outside its design criteria or place yourself under a suspended load.
NEVER: Enter a restricted / barricaded area without authorisation.
NEVER: Work at height without using the required personal fall protection device.
NEVER: Fail to immediately report all incidents, injuries and near miss incidents (no matter how minor).

Assessment

Name three points all personnel must take reasonable care to do in relation to duty of care:

Duty of Care #1 *

Duty of Care #2 *

Duty of Care #3 *

What are Centrals company core values?

Core Values #1 *

Core Values #2 *

Core Values #3 *

Name four major hazards associated with Centrals work

Major Hazard #1

Major Hazard #2

Major Hazard #3 *

Major Hazard #4 *

Is it OK to approach a machine before getting the Operator's attention? *

YesNo

What is the accepted BAC % level for a person to commence work? *

What are the signs of heat stress?

Heat Stress Sign #1 *

Heat Stress Sign #2 *

Heat Stress Sign #3 *

Heat Stress Sign #4 *

What is the purpose of a JHA (Job Hazard Analysis)? *

Centrals personnel can smoke in light vehicles or machines? *

YesNo

Who participates in JHA development? *

Which of the following is the highest cause of unsafe work? *

NatureUnsafe ConditionsUnsafe acts or behaviours

When would you conduct a Stop Think Go? *

End of the jobTo replace a JHAAt the start of a new task

All persons who are working at heights or in confined spaces are required to have been trained and be accredited before undertaking the activity? *

TrueFalse

Who may carry out work on electrical installations? *

Anyone as long as they have had an induction
Anyone with electrical knowledge
An electrician who is registered and meets site requirements
Supervisor

When working on plant or machinery, what must you place on the isolation point? *

Information TagOut of Service TagPersonal Danger Tag and Lock

Why do you use an out of service tag? *

To protect yourself when you are working on the faulty equipmentProtect plant and equipmentYou don't have any danger tags

What does MSDS stand for?

'M' in MSDS stands for? *

'S' in MSDS stands for? *

'D' in MSDS stands for? *

'S' in MSDS stands for? *

All mobile equipment must undergo pre-start checks and inspections? *

TrueFalse

All operators must be trained and deemed competent before operating mobile equipment on site? *

TrueFalse

All personnel must attend pre-start meetings on site? *

TrueFalse

The incidence of Slips, Trips & Falls can be reduced by? *

Good housekeepingWorkplace inspectionsBarricadingAll of the above

When using Electrical Equipment it must be protected by an RCD? *

TrueFalse

Whom do you report incidents or accidents to? *

When do you report incidents or accidents on site? *

What do the three C's stand for in relation to oil or fuel spills?

C #1 in relation to spills *

C #2 in relation to spills *

C #3 in relation to spills *

Statement of Commitment agreement

Please tick the below: *

I agree to abide by Centrals CEM Policies and Procedures and not put myself or my colleagues at risk of injury or incident.
I understand and accept the reasons for Centrals CEM implementing the Policies and Procedures and the intent of these.
In the event I am at any time unsure about the application of a particular Policy or Procedure, I commit to STOPPING the job and asking for assitance.
I understand the consequences of failing to abide by Centrals CEM Policies and Procedures, in particular the potential for disciplinary action, up to and including the possibility of termination of employment to occur.

Inductee Confirmation

Full Name *

Declaration Date *

Centrals

Personal Information

Licence and Qualification Details

Drivers Licence

Construction Card

Medical Advice

Declaration

Induction

Assessment Questions

Statement of Commitment

Assessment

Name three points all personnel must take reasonable care to do in relation to duty of care:

What are Centrals company core values?

Name four major hazards associated with Centrals work

What are the signs of heat stress?

What does MSDS stand for?

What do the three C's stand for in relation to oil or fuel spills?

Statement of Commitment agreement

Inductee Confirmation