SUBCONTRACTOR HSE DOCUMENTATION PACK USER GUIDE
Contents
1. Organisation Details Organisation Name Contact Name ACN ABN Contact Position Address Contract Phone No Project Activity Resources Trades Involved Equipment Used Maintenance checks Materials Used PPE Circle Highlight all that apply EYE DUST MASK masrpe wonn romero HEARING FOOT PROTECTION PROTECTION MUST BE WORN MUST BE WOR FACE SHIELD MUST BE WORN Codes or Standards applicable to the works Occupational Health Safety or Environmental Legislation ISSUE DATE INSERT ISSUE DATE P1 4 lt INSERT COMPANY LOGO gt Likelihood Probability L M U Likely Moderate Unlikely Level Description of Consequence or Impact Consequence H 1 Potential death permanent disability or major structural failure damage Off site environmental H 1 High level of harm discharge release not contained and significant long term environmental harm High M 2 Potential temporary disability or minor structural failure damage M 2 On site environmental discharge release contained minor remediation required short term Medium level of harm Medium environmental harm L 3 Incident that has the potential to cause persons to require first aid L 3 Low level of harm On site environmental discharge release immediate2. Resources Trades Involved Equipment Used Maintenance checks Materials Used PPE Circle Highlight all that apply Occupational Health Safety or Environmental Legislation ISSUE DATE INSERT ISSUE DATE gt SAFE WORK METHOD STATEMENTS DEVELOPMENT OF A SWMS The Regulations require the development and adherence to a SWMS for all activities that are classified as high risk as noted above The development of SWMS s should be linked to the up front risk assessment Therefore Monaco Hickey expects that SWMS s are site specific and are only provided for activities to be undertaken on site I E we do not want generic SWMS Packs A sample SWMS and a copy of Monaco Hickey s SWMS Template are provided in the document pack for use as required THE LEGAL PERSPECTIVE Part 5 1 9 of the Regulations state that an employer must not perform high risk construction work if there is a risk to the health or safety of any person arising from the work unless a a Safe Work Method Statement is prepared for the work before the work commences and b the work is performed in accordance with the statement Further the Regulations define a SWMS as being a document that a identifies work that is high risk construction work and 8 16 4 2 lI MONACO HICKEY b states the hazards and risks to health or safety of that work and c sufficiently describes measures to control those risks and d describ
3. amp equipment register incl electrical amp lifting gear amp records of maintenance inspection risk assessments and where relevant registration by the Regulatory Authority PPE register of supply to employees or contractors engaged by the Subcontractor Training register of employees contractors including OHS General Industry Induction safety awareness training Training in HSE Management Plan amp SWMS JSA s Training in use hazardous substances or dangerous goods to be used Certificates Licences Register for those tasks that require a certificate licence of competency or High Risk Work Licence Qualifications amp training of key personnel with HSE management supervisor duties MONACO HICKEY Scope of work Signature i Further Action Comments YesL NoL YesL NoL Yes No YesL Nol YesL NoL YesL NoL N AL Yes No YesL NoL Yes No Yes No Yes No Yes No YesL NoL YesL Nol HSE FM 059 1 Page 1 Health Safety amp Environmental Form Subcontractor Documentation Checklist HSE Documentation Review PF Further Action Comments p Workplace consultation arrangements agreed for Yes Nol employees contractors engaged by the Subcontractor including Tool Box Talks Pre Start Meetings q Hazardous Substances Dangerous Goods register YesL Nol along with Material Safety Data Sheet with an issu
4. Depending on the nature of the contract works to be carried out and the environmental issues and risks aspects amp impacts associated with your scope of works you may be required to submit an environmental management plan The Environmental Management Plan will take into account and environmental hazards and risks aspects amp Impacts that need to be managed in completing your scope of works Contact your Monaco Hickey project contact to understand what is required from you for an Environmental Management Plan HSE MP 105 2 ISSUE DATE 8 April 2014 16 16 Health Safety amp Environmental Form Subcontractor Documentation Checklist Workplace Subcontractor Date of Review Reviewed by name HSE Documentation Review Company details a b C ABN Address and contact details Scope of work description Policy for Safety Environment signed amp dated Responsibility accountabilities for key personnel with HSE management supervisor duties Organisational flow chart showing the management reporting structure for HSE Nominated OHS Rep appointed trained SWMS JSA s or equivalent detailing hazards risks impacts amp control measures to be implemented NOTE SWMS Review Form to be completed Person to monitor effectiveness of control measures in HSE Management Plan amp SWMS Risk Assessment detailed of the tasks to be completed as per scope of works Plant
5. OF CONTROL Best forms of control to use where possible Start at the top and work down to find the most practical Substatution solution Elimination Engineering Where possible should only be used in conjunction with controls above Administration Personal Protective Equipment PPE HSE MP 105 2 ISSUE DATE 8 April 2014 9 16 5 0 5l 5 2 5 3 5 4 HSE MP 105 2 ISSUE DATE 8 April 2014 IllimoNAco HICKEY INCIDENT AND INJURY MANAGEMENT Ensuring that appropriate incident and injury management processes are in place is a critical element in reducing future incidents learning from past events remaining legislatively compliant and minimising down time Monaco Hickey has the following expectations for the management of any incident or injury INJURIES REQUIRING FIRST AID If an injury requires first aid it is critical that you notify a Monaco Hickey First Aid Attendant of the injury All injuries that receive first aid treatment require a Register of Injuries Form to be completed The Register of Injuries Form has three primary purposes 1 The Form protects the individual that was injured by ensuring that there is a record of the occurrence This is important as a number of seemingly minor injuries can lead to future complexities that require a workers compensation claim to be lodged Without the initial Register of Injuries Form proving that the condition occurred at work can be dif
6. contractor s business For the purpose of this Subcontractors Statement a principal contractor is a person or other legal entity who has entered into a contract with another person or other legal entity referred to as the subcontractor and employees workers of that subcontractor will perform the work under contract The work must be connected to the business undertaking of the principal contractor Provide the unique contract number title or other information that identifies the contract In order to meet the requirements of s127 Industrial Relations Act 1996 a statement in relation to remuneration must state the period to which the statement relates For sequential Statements ensure that the dates provide continuous coverage Section 127 6 of the Industrial Relations Act 1996 defines remuneration as remuneration or other amounts payable to relevant employees by legislation or under an industrial instrument in connection with work done by the employees Section 127 11 of the Industrial Relations Act 1996 states to avoid doubt this section extends to a principal contractor who is the owner or occupier of a building for the carrying out of work in connection with the building so long as the building is owned or occupied by the principal contractor in connection with a business undertaking of the principal contractor Provide the date of the most recent payment claim For Workers Compensation purposes an exempt employer is an
7. employer who pays less than 7500 annually who does not employ an apprentice or trainee and is not a member of a group In completing the Subcontractors Statement a subcontractor declares that workers compensation insurance premiums payable up to and including the date s on the Statement have been paid and all premiums owing during the term of the contract will be paid In completing the Subcontractors Statement a subcontractor declares that all remuneration payable to relevant employees for work under the contract has been paid In completing the Subcontractors Statement a subcontractor declares that all payroll tax payable relating to the work undertaken has been paid It is important to note that a business could be both a subcontractor and a principal contractor if a business in turn engages subcontractors to carry out the work If your business engages a subcontractor you are to also obtain Subcontractors Statements from your subcontractors STATUTORY DECLARATION ACT ONLY Statutory Declaration by Consultant l of Insert name Declarant do solemnly and sincerely declare that 1 am a representative of Consultant in the Office Bearer capacity of Insert address The Consultant has a contract with the Head Contractor to carry out certain services for Insert name of Agreement Consultant and 3 All amounts payable to a tradesperson or worker as defined in section 4 of the Contractor
8. nnne eene 14 7 2 Monaco Hickey s expectations iien kinai suena nannte nna tain renee salt R n ada ama aa sau DEEP a RXRRR RE ERES aac a RR EE 15 8 0 HAZARDOUS SUBSTANCES AND DANGEROUS GOODS sees enne 15 nos TEILTE 15 8 2 Legal Requiremients ecce sk a ux aae REOR Fee Tuae Gh ar pasa ea Qd RARE VERDE APER ERES 15 8 3 Monaco Hickey s expectations essssssessssseseenesesehunenasnnasn ness sese su sank ae sa da ausa kna asa 16 9 0 ENVIRONMENTAL MANAGEMENT 4 eensseesssaseune annuae ania uiua u ana u suus iusa uasa sna uan u aun 16 HSE MP 105 2 ISSUE DATE 8 April 2014 3 16 1 0 2 0 3 0 HSE MP 105 2 ISSUE DATE 8 April 2014 IllimoNAco HICKEY INTRODUCTION Monaco Hickey has developed the following Subcontractor HSE Documentation Pack with the intent of providing our subcontractors with a set of standard templates to facilitate commencement on site Further this documentation pack is aimed at removing generic and or irrelevant documents that are typically found in standard Subcontractor HSE Documentation Packs Complying with this Subcontractor HSE Documentation Pack will assist subcontractors to meet their legislative requirements under the current Victorian OHS Act and Regulations However subcontractors should always seek professional advice to ensure that their company remains compliant This document is intended on complimenting a company s existing system and provides basic te
9. that a person e Any other person listed making a false declaration in Section 107A 1 of is liable to the penalties of the Evidence Act 1958 perjury Western Australia Oaths Affidavits and This declaration is true e A justice of the peace Statutory Declarations Act and know that it is an e A lawyer 2005 offence to make a e A public notary declaration knowing that it e Any other person listed is false in a material particular in column 2 of Schedule 2 of the Oaths Affidavits and Statutory Declarations Act 2005 Northern Territory Oaths Act 1939 And make this solemn declaration by virtue of the Oaths Act and conscientiously believing the statements contained in this declaration to be true in every particular e A justice of the peace A commissioner for oaths Australian Capital Territory Statutory Declarations Act 1959 Cth understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959 and believe that the statements in this declaration are true in every particular A justice of the peace A lawyer A notary public Any other person listed in Schedule 2 of the Statutory Declarations Regulations 1993 Cth
10. Ill MONACO SUBCONTRACTOR HSE DOCUMENTATION PACK USER GUIDE HSE SUBCONTRACTOR HSE DOCUMENTATION PACK 1 0 LIST OF DOCUMENTS 01 Monaco Hickey HSE Documentation Checklist 02 Project Hazard Identification Based on Contract Scope of Works 03 SWMS Template 04 Monaco Hickey SWMS Review Sheet 05 Sample Suitable Alternative Duties 06 Plant Review Checklist 07 Hazardous Substance amp Dangerous Goods Register NOTE the required HSE documentation must be submitted prior to contractor commencement on site 2 0 REGISTER OF REVIEW MONACO HICKEY Version Date 8 April 2014 Version No 2 Revised By Shane Hickey Role HSEQ Coordinator Authorised Joe Monaco Role Construction Manager By Director Section Description of Amendments Version Date All New document 1 1 5 2011 All Review and amend for new HSE System 2 8 4 2014 HSE MP 105 2 ISSUE DATE 8 April 2014 1 1 IllimoNAco HICKEY This document has been developed to assist subcontractors to meet Monaco Hickey s Environmental Health and Safety HSE requirements whilst working on a Monaco Hickey Project The document should be able to be used as a template to assist your organisation to meet a number of the key legislative requirements outlined in the Victorian OHS Act 2004 and the Victorian OHS Regulations 2007 Further Monaco Hickey acknowledges that with the rollout of the h
11. MENT The OHS Act and Part 3 5 of the Victorian OHS Regulations 2007 more specifically Division 5 require that an employer manages all risks associated with the use of Plant and Equipment so far as is reasonably practicable 13 16 7 1 HSE MP 105 2 ISSUE DATE 8 April 2014 IllimoNAco HICKEY Due to the volume of Plant amp Equipment commonly used on construction sites and the varying risk associated with each item and its use a risk management approach is required to ensure that the high risk items of plant receive the attention required to prevent incidents from occurring Monaco Hickey has developed a list of common Plant amp Equipment that is identified as having additional risks and therefore requires more stringent control to ensure its appropriate management on site The controls implemented to manage these additional risks include but not limited to e Plant Inductions and e Review of daily Plant amp Equipment checks Plant included on the list are as follows but not limited to e Bob Cat e Hoist material e Back Hoe e Hoist personnel amp material e Boom Lift e Lifts e Building Maintenance Unit e Lifting Equipment e Crawler Crane e Mast Climbing Platform e Concrete Pump e Mobile Crane e Concrete Placing Unit e Non Slewing Mobile Crane e Drilling Rig e Piling Rig e Electrical Pallet Jack e Roller Compactor e Excavator e Scaffolds e EWP Other e Scissor Lifts e Fork Lift e Tower Crane e Gen
12. On or near pressurised gas distribution mains or piping On or near chemical fuel or refrigerant lines On or near energised electrical installations or services In an area that may have a contaminated or flammable atmosphere Involving tilt up or precast concrete On or adjacent to roadways or railways used by road or rail traffic At workplaces where there is any movement of powered mobile plant In an area where there are artificial extremes of temperature In over or adjacent to water or other liquids where there is a risk of drowning Diving If the scope of works incorporates any of the activities set out above a site and project specific task Safe Work Method Statement SWMS IS required NOTE Monaco Hickey will not accept generic SWMS s for activities that fall under the category of High Risk Construction Work Please complete the analysis in the table on the following page to match the high risk tasks in your contracted scope of works against the hazards involved ISSUE DATE lt INSERT ISSUE DATE gt P1 2 lt INSERT LOGO COMPANY NAME gt PROJECT HAZARD IDENTIFICATION BASED ON CONTRACT SCOPE OF WORKS Activity Potential High Risk Activities SWMS Required Y N Name of SWMS ISSUE DATE INSERT ISSUE DATE P2 2 lt INSERT COMPANY LOGO gt SAFE WORK METHOD STATEMENT
13. SERT LOGO HERE gt SUITABLE DUTIES EMPLOYMENT STATEMENT OF CAPABILITIES Having undertaken a thorough examination of I conclude that o He she is fit for return to normal duties L1 At this time he she is not fit for alternate duties or a return to normal duties see medical certificate provided o He she is fit for restricted duties at this time which may include visual tasks only e g inspection lifting restricted to kilograms working with arms above head light bench work only sitting position only and or driving vehicles including forklifts numini which may not include oO work involving repetitive bending twisting lifting E work involving the right left hand arm shoulder leg Prescribed medication that may influence the workers ability to operate plant and or equipment or otherwise impair his her ability to work safely Yes No Recommended hours of work Date of review appointment Doctors Signature Date Alternate duties as selected by the return to work coordinator EHS facilitator or other ISSUE DATE lt INSERT DATE gt P12 lt INSERT LOGO HERE gt POTENTIAL ALTERNATE DUTIES PLACE AN X IN ALL THAT APPLY General site office housekeeping Description of task Employee is required to clean sweep and maintain cleanliness and orderly condition of the site office Physical requirement Standing walking with minimal bend
14. Table e Working at heights y Formwork Erection Form greater than 2 metres SWMS e Working with powered General Lifting SWMS mobile plant Concrete Pumping e Working with powered Y Concrete Pumping SWMS mobile plant Finishing concrete e Nil N N A screeding Formwork Stripping e Working at heights Y Formwork Stripping greater than 2 metres SWMS e Working with powered Use of Forklift SWMS mobile plant Forklift Pre cast panel erection e Pre cast panel erection Y Pre cast panel erection e Powered mobile plant cranes e Powered mobile plant scissor Lift boom lift SWMS General Lifting SWMS HSE MP 105 2 ISSUE DATE 8 April 2014 6 16 IllimoNAco HICKEY Activity Potential High Risk SWMS Name of SWMS Activity Required Y N Prop removal e Powered mobile plant Y Use of Scissor Lifts scissor Lift boom lift SWMS Use of Boom Lifts SWMS HSE MP 105 2 ISSUE DATE 8 April 2014 7 16 4 0 4 1 HSE MP 105 2 ISSUE DATE 8 April 2014 lI MONACO HICKEY While the Vic OHS Regulations only require a SWMS to be completed for high risk activities Monaco Hickey recommends that SWMS s are developed for activities being completed for the first time or are unique For example using a tool or product for the first time INSERT COMPANY LOGO gt SAFE WORK METHOD STATEMENT Organisation Details Organisation Name Project Details Activity
15. amme in place as per the requirements of Section 156 of the Accident Compensation Act 1985 The legislation specifically states that an Occupational Rehabilitation Programme must include e astatement of the employer s return to work policy and e the name of a return to work co ordinator nominated by the employer and e the name of at least one approved provider of occupational rehabilitation services who will be available to provide services where reasonably necessary for the return to work and maintenance at work of an injured worker and e provide for any additional matters specified by the Authority and e be developed by the employer in consultation with the workers of the employer and e bein writing 6 1 MONACO HICKEY S EXPECTATIONS If a subcontractor employees more than 10 people including office staff and wages employees it is expected that the company will provide Monaco Hickey with e Acopy of the company s Return to Work Policy and e A list of suitable alternative duties that could be performed by an injured employee note use of the WorkSafe Victoria sponsored CFMEU Return to Work document is acceptable The following must be supplied for all subcontractors regardless of size e Acopy of the company s current Workers Compensation Certificate of Currency and e The name of the Return to Work Co ordinator appointed by the company 7 0 HSE MP 105 2 ISSUE DATE 8 April 2014 PLANT AND EQUIP
16. armonised national OHS Act and Regulations in January 2012 there may be some requirement for minor changes to this document However it is anticipated that all of the fundamental information within the document will remain unchanged Note This document is for guidance purposes only Monaco Hickey does not accept any liability for the use of this document or any losses incurred as a result of using this document HSE MP 105 2 ISSUE DATE 8 April 2014 2 16 lI MONACO HICKEY INDEX 1 0 INTRODUCTION sasteccaseericnsscctatcsctesccascnsescsadaencsdsauceadsaucucntessasusvcatevenscsudcbavenacseassssnns neceaauennes 4 2 0 DEFINITIONS wash teauisctueduatenaces taneusaavacecncetaatvivuracnasedteaeasaatacadecuraatatvavect Saa CUR 22d 8e qu dads Fab AO aS duo 4 3 0 RISK MANAGEMENT 5 ness r naves aae naS Pus sa APESEERSuESPRI PR 3REQRR SES ES ERR SREUSR SuxCUNSPERASESRR RES PARE senses 4 3 1 Conducting a preliminary hazard identification based on your scope of works 5 3 2 Monaco Hickey s Expectations iex semen eek teneo pe sex xd aie a ra Rd RN SR ier Fr RR Rad PE ses ai 6 3 2 1 ABC Painting Sample hazard identification based on scope of works eee 6 3 2 2 XYZ Structures Sample hazard identification based on scope of works ssessssse 6 4 0 SAFE WORK METHOD STATEMENTS esse esseuseuneanmann uia an unu nananana iussu aane inan un unn 8 4 1 Development of a SWMS
17. contractor has entered into a contract with ABN Business name of principal contractor Note 2 Contract number identifier Note 3 This Statement applies for work between and inclusive Note 4 subject of the payment claim dated Note 5 li iere iet edu idt cde eek msec a Director or a person authorised by the Subcontractor on whose behalf this declaration is made hereby declare that am in a position to know the truth of the matters which are contained in this Subcontractors Statement and declare the following to the best of my knowledge and belief a The abovementioned Subcontractor has either employed or engaged workers or subcontractors during the above period of this contract Tick if true and comply with b to g below as applicable If it is not the case that workers or subcontractors are involved or you are an exempt employer for workers compensation purposes tick and only complete f and g below You must tick one box Note 6 b All workers compensation insurance premiums payable by the Subcontractor in respect of the work done under the contract have been paid The Certificate of Currency for that insurance is attached and is dated Note 7 c All remuneration payable to relevant employees for work under the contract for the above period has been paid Note 8 d Where the Subcontractor is required to be registered as an employer under the Payroll Tax Act 2007 the Subcontractor has pai
18. d 2 Without affecting the generality of subregulation 1 the occupier when identifying hazards must have regard to a Any information about the hazardous properties inherent to the dangerous goods including a MSDS for the dangerous goods available to the occupier HSE MP 105 2 ISSUE DATE 8 April 2014 15 16 l MONACO HICKEY Further Section 4 1 23 of the Victorian OHS Regulations requires an employer to ensure that a register is prepared and maintained in accordance with subregulation 2 of all hazardous substances supplied to the employer s workplace PLAIN ENGLISH INTERPRETATION An MSDS is to be supplied for all Hazardous Substances and Dangerous Goods that are to be brought onto site All substances are to have their risks reviewed to ensure that they are the most appropriate substance for their intended application E g where possible utilising water based acrylic paints instead of oil based paints Further a register of all hazardous substances and dangerous goods is to be maintained 8 3 MONACO HICKEY S EXPECTATIONS An MSDS is to be supplied for all Hazardous Substances and Dangerous Goods that are to be brought onto site The Hazardous Substance Register is to be updated with approximated quantities and submitted to a Monaco Hickey HSE Coordinator or Foreman each month while on site All storage areas are to have appropriate signage displayed 9 0 ENVIRONMENTAL MANAGEMENT
19. d all payroll tax due in respect of employees who performed work under the contract as required at the date of this Subcontractors Statement Note 9 e Where the Subcontractor is also a principal contractor in connection with the work the Subcontractor has in its capacity of principal contractor been given a written Subcontractors Statement by its subcontractor s in connection with that work for the period stated above Note 10 f SIghaturea sse hen Aenea nnn Full lame eR P dee eed da g Position Title re NA Ere ENT yess YRHETE CE XUI E Pv e WEE raia Date NOTE Where required above this Statement must be accompanied by the relevant Certificate of Currency to comply with section 175B of the Workers Compensation Act 1987 10 Notes This form is prepared for the purpose of section 175B of the Workers Compensation Act 1987 Schedule 2 Part 5 Payroll Tax Act 2007 and section 127 of the Industrial Relation Act 1996 If this form is completed in accordance with these provisions a principal contractor is relieved of liability for workers compensation premiums payroll tax and remuneration payable by the subcontractor A principal contractor can be generally defined to include any person who has entered into a contract for the carrying out of work by another person or other legal entity called the subcontractor and where employees of the subcontractor are engaged in carrying out the work which is in connection with the principal
20. d is not disturbed until a an inspector arrives at the site or b such other time as an inspector directs when the Authority is notified of the incident Penalty 60 penalty units for a natural person 300 penalty units for a body corporate 2 Despite sub section 1 a site may be disturbed for the purpose of a protecting the health or safety of a person or b aiding an injured person involved in an incident or c taking essential action to make the site safe or to prevent a further occurrence of an incident HSE MP 105 2 ISSUE DATE 8 April 2014 11 16 lI MONACO HICKEY PLAIN ENGLISH INTERPRETATION If there is an incident that falls into any of the categories listed as being notifiable the scene may only be disturbed if WorkSafe or a WorkSafe Inspector advises that it is ok to disturb the scene or Preservation would cause an immediate risk to health and safety or The scene is disturbed by the removal of an injured person from the incident scene 5 4 2 DUTY TO NOTIFY The duty to notify WorkSafe of incidents that fall into the categories listed in 4 2 resides with the Employer that is involved in the incident The legislation states 1 An employer or self employed person must notify the Authority immediately after becoming aware that an incident has occurred at a workplace under the management and control of the employer or self employed person 2 However an employer or self employed person is n
21. ding and observing with periodic ability to sit Updating checking plant and equipment log books safety checks Description of task Employee to visually check plant and equipment on site to ensure safety items and details have been documented Physical requirement Walking and observing with minimal bending and some writing Identifying and assessing site safety hazards Description of task Employee is required to walk around site and document and identify if and where safety hazards exist Physical requirement Walking and observing with periodic requirement to make notes write Safety signage and barricading work Description of task Employee is required to use cans of spray paint to maintain safety signage and also to check maintain and relocate barrier meshing where required Physical requirement Walking with minimal bending reaching and lifting of items less than 5kg Site tools storeman Description of task Employee is required to maintain an orderly tools areas check all tools for damage and fill in a register of where and who is using tools and equipment on site Physical requirement Walking with periodic sitting in a tools storage area with minimal bending reaching and lifting of items less than 10kg Lift Alimak Driver Description of task Employee is required to operate the lift or alimak for goods and personnel transport Physical requirement May require assistance with loading and unloading the lift pers
22. e date not greater than 5 years for each and every product or substance to be used and risk assessments for products classified as hazardous dangerous goods r Workers Compensation amp Public Liability Insurance Yes Nol certificates of currency verified amp copies supplied s Incident reporting procedure for injury near miss Yes NoL environment plant damage or other commitment to report to Monaco Hickey Constructions t Injury Management Register of Injuries Return To Yes NoL Work provider details Letter of Introduction to treating medical provider amp list of Suitable Duties provided commitment to report to Monaco Hickey Constructions u Hazard Reporting procedure for reporting and Yes Nol managing identified hazards commitment to report to Monaco Hickey Constructions Subcontractors Any subcontractors you use at the workplace MUST provide all documents listed above The following subcontractors are to be utilised at this workplace and will be reporting to us Subcontractor Task Subcontractor Task Subcontractor Task A separate documentation required checklist and attachments has been included with the submission Personal Protective Equipment At a minimum Monaco Hickey requires the following PPE to be worn at all times Safety boots High visibility clothing Safety helmets A Additional PPE is as the task requires It is the contractors subcontractors respo
23. er injury to a person or other consequence prescribed by the regulations This Part also applies to an incident that exposes a person in the immediate vicinity to an immediate risk to the person s health or safety through e the collapse overturning failure or malfunction of or damage to any plant that the regulations prescribe must not be used unless the plant is licensed or registered or e the collapse or failure of an excavation or of any shoring supporting an excavation or e the collapse or partial collapse of all or part of a building or structure or e an implosion explosion or fire or e the escape spillage or leakage of any substance including dangerous goods within the meaning of the Dangerous Goods Act 1985 or e the fall or release from a height of any plant substance or object or If an incident falls into any of the categories noted above Monaco Hickey must be immediately notified to ensure that WorkSafe and other relevant parties are informed in an appropriate and timely manner 5 4 1 SCENE PRESERVATION If an incident occurs on site and falls into any of the categories listed above the scene of the incident requires preservation i e the area should be taped off to prevent access The legislation relating to scene preservation states 1 An employer or self employed person who is required to notify the Authority of an incident that has occurred at a workplace must ensure that the site where it occurre
24. erators greater than SOKVA e Traxcavator e Grader PLANT REVIEW PROCESS PLANT INDUCTIONS Monaco Hickey s Plant induction review process requires the supplier of the plant to provide the following details not exhaustive for each item of plant brought to site that falls within the categories outlined on the list above e The type of plant e The date last serviced e Details of the Plant Risk Assessment e Details of maintenance records including records for 10 year checks if applicable Further to the above the supplier of the plant is required to sign a verification that the plant is fit for purpose and has been serviced maintained in accordance with the manufacturers recommendations A copy of Monaco Hickey s Plant Review Form is provided in the Subcontractor Documentation Pack for information only 14 16 IllimoNAco HICKEY 7 2 MONACO HICKEY S EXPECTATIONS Monaco Hickey s expectations of our subcontractors are as follows e Monaco Hickey s Foremen HSE Coordinators are to be provided with notification and appropriate documentation for all Plant amp Equipment being brought onto site that falls within the categories listed on the Common Plant amp Equipment Checklist e The plant supplier is to complete the Plant Review Form and supply it at the time of the plant induction e No Plant amp Equipment that falls within the categories listed on the Common Plant amp Equipment List is to be used on site with
25. ere are artificial extremes e a trench or shaft if the excavated depth is of temperature more than 1 5 metres e in over or adjacent to water or other liquids e a tunnel f f where there is a risk of drowning e the use of explosives T e diving e on or near pressurised gas distribution mains or piping e on or near chemical fuel or refrigerant lines 5 16 3 2 MONACO HICKEY S EXPECTATIONS Prior to commencement on a Monaco Hickey project it is expected that Hazard Identification based on the contract scope of works is completed MONACO HICKEY Two non exhaustive examples are shown below that lists the activities of a painting contractor and a structure contractor 3 2 1 Activity Potential High Risk Activity SWMS Required Y N ABC PAINTING SAMPLE HAZARD IDENTIFICATION BASED ON SCOPE OF WORKS Name of SWMS Painting from the ground e Nil N N A using a roller Painting from a boom lift e Working at heights Y Painting from Boom Lift using a roller greater than 2 metres SWMS e Working with powered mobile plant Painting ceiling on e Working at heights Y Painting Balcony Ceilings balconies using a brush greater than 2 metres using a Ladder SWMS 3 2 2 XYZ STRUCTURES SAMPLE HAZARD IDENTIFICATION BASED ON SCOPE OF WORKS Activity Potential High Risk Activity SWMS Required Y N Name of SWMS Formwork erection
26. ers in the area e It ensures that you go through the sequence of works to determine if additional resources are required so that there is limited impact on costs mid project e It will ensure that you identify all of the activities that will require the implementation of a SWMS as per the requirements of the Victorian OHS Regulations e You are able to minimise the amount of documentation required by addressing areas that are site specific and relevant to the job being undertaken e Once complete it is a good tool to discuss with people working on the job to determine if there are any potential issues that may not have been thought through in the planning phase HIGH RISK CONSTRUCTION WORK The Victorian OHS Regulations Part 5 Construction section 5 1 3 define High Risk Construction work as being work that involves one or more of the following e where there is a risk of a person falling more e on or near energised electrical installations than 2 metres or services e on telecommunications towers e in an area that may have a contaminated or e demolition flammable atmosphere e the removal or likely disturbance of e involving tilt up or precast concrete asbestos e on or adjacent to roadways or railways used e Structural alterations that require temporary by road or rail traffic support to prevent collapse e at workplaces where there is any movement e a confined space of powered mobile plant e in an area where th
27. es the manner in which the risk control measures are to be implemented Failure to comply with the requirements outlined in section 5 1 9 of the Regulations may be seen as a breach against sections 21 and 23 of the Act If found guilty a company could be liable to pay fines of up to fines of 215 010 for a natural person and 1 075 050 for a body corporate if a SWMS is not completed or followed for a high risk construction activity REVIEW OF SWMS S To ensure that legislative requirements are upheld and Monaco Hickey achieves industry best practice Monaco Hickey s Management will assess all SWMS s against the following criteria e Are hazards amp risks associated with the task clearly identified in the SWMS e Have site specific considerations been taken into account during the development of the SWMS e Are control measures outlined in the SWMS relevant and in keeping with the hierarchy of control e Isthe SWMS current for the activity being undertaken ie site specific considerations remain unaltered not more than 1 year old e Isrelevant legislation identified on the SWMS e Does the SWMS include record of a toolbox talk or signoff from the workers using the SWMS If the SWMS produced does not meet the requirements listed above the SWMS will be rejected and works will not be permitted to commence until the issues are rectified A copy of Monaco Hickey s SWMS Review sheet is provided in the documentation pack HIERARCHY
28. esee rine a tk ninn iaa ANTA AA A EETA AEAEE Gaia 8 4 2 Review of SWMS S ciii cose oandecdccecgedin Saxa eb u E Reni DEMEURE RETE NM DURN RUP ARRXIFI D NMNEFTA RE DFEE 9 5 0 INCIDENT AND INJURY MANAGEMENT sseesnsseeeeaneunn uiua enu aeui us asas u annu anas 10 5 1 Injuries requiring first aid 2 rrr cesta br Din ERE RIR QE ROI CIR EN ERR NIA ROREM RR NE ep aha ds 10 5 2 Medical Treatment Injuries Monaco Hickey s Expectations ssesssseeeen 10 5 3 Management of Lost Time Injuries Monaco Hickey s Expectations ssssssssserrssrrrrserrreesrns 10 5 4 Incidents that require statutory notification sssssssssssssssese nennen 10 5 4 1 SCENE PrESEMnVAllON UU 11 5 4 2 DUty to NOtify scceiict ids convene a valde ance wah ables adnate ead Leased ae vce eee dee 12 5 4 3 Monaco Hickey Expectations for Incident Notification and Scene Preservation 13 5 4 4 Near miss incidents uoce iae derer onerata xk granata ra vicia n eame ts cc EE E FERIA Fa nM cS 13 6 0 RETURN TO WORNK is esn sana dinaanan ninaa eR ERR ER SRREEERRSRERR ERR PERRA REERERSR ERR RRR ERR EASEZARENEERESARERES 13 6 1 Monaco Hickey s expectations siidri traria tx RR DR sans RR RA DER RR asec ERR RATER RE PN seats 13 7 0 PLANT AND EQUIPMENT iscdss vexat S v susudust 95805300 ERE CIRNI TOME TAR TESI E48 4uE SE Ra ENS ExIA VE eSETRa Pn FIERE 13 7 1 Plant Review Process Plant Inductions sssssssssssssesssene
29. ficult and could potentially lead to the claim being disputed 2 The Register of Injuries Form assists in determining whether additional investigation into the cause of the injury is required and 3 Monaco Hickey uses the Register of Injury Forms to determine trends in injury types and causes and then implements initiatives to reduce the risk of similar injuries occurring MEDICAL TREATMENT INJURIES MONACO HICKEY S EXPECTATIONS In circumstances where a worker is injured and requires medical treatment Monaco Hickey expects the following to occur e Arepresentative of the injured worker is to attend to the medical clinic with the injured worker e A letter of introduction is to be taken with the injured worker and supplied to the medical practitioner for review e A list of suitable alternative duties is to be taken into the medical consultation for review by the doctor where a company does not have their own list of suitable alternative duties the WorkSafe sponsored CFMEU return to work document should be used e Following the medical consultation the person who attends the clinic with the injured worker is to contact Monaco Hickey Site Management and notify them of the outcomes Samples of the documents referred to above are provided as attachments MANAGEMENT OF LOST TIME INJURIES MONACO HICKEY S EXPECTATIONS In circumstances where a worker is provided with time off work by a registered medical practitioner due to a wo
30. ge refuelling oil or YesL NoL hydraulic fluid leakage acid sulphates L Vehicle movement workplace access mud and YesL NoL rumble grid wheel wash h Control measures that shall be applied to the YesL NoL identified hazards impacts including High Risk Work Tasks are adequate i List person s responsible for ensuring each of YesL Nol the control measures are implemented Ill MONACO HSE FM 061 1 pg Health Safety amp Environmental Form SWMS Review j Plant amp equipment to be used in the work process Yes Nol and records provided k Products hazardous substances dangerous YesL NoL goods to be used in the work process and records provided l Legislation standards or codes of practice Yes No references relevant to the work m Qualifications of the personnel that shall YesL Nol undertake the work n Training or permits required for those undertaking Yes Nol the work o Record of induction for employees contractors into Yes Nol the SWMS or equivalent risk assessment p Other issues Review outcome ID SWMS accepted no amendment Li SWMS accepted minor amendment Li SWMS rejected major amendment Li Q N Y B fo r nformatio n Corrective action required Reviewed by Name Signature Site Manager Site Supervisor Name Signature COPY TO SUBCONTRACTOR Date Ducesen isasvesscons Date Date IlimoNAco HICKEY HSE FM 061 1 pg lt IN
31. ing sweeping reaching wiping General amenities cleaning Description of task Employee is required to maintain site amenities including clearing and cleaning tables removing rubbish restocking tea coffee sugar milk May include cleaning floors including moping and the cleaning of the ablutions sheds Physical requirement Walking with minimal bending reaching and lifting of items less than 5kg General worksite housekeeping Description of task Employee is required to sweep work areas and pick up small debris and offcut materials placing them into wheelie bins on identified forklift bins Physical requirement Walking with minimal bending reaching and lifting of items less than 5kg General safety document reading reviewing and filing Description of task Employee is required to read sort photocopy and file drawings and other documents located in the site office Physical requirement Standing and or sitting with minimal bending some reading reaching and writing Traffic Control Description of task Employee located at specific areas on site to direct vehicles entering and leaving to assist trucks reversing and direct traffic around altered thoroughfares Physical requirement Standing and directing using hand arm movements with periodic ability to site Spotter Description of task Employee located on site to visually ensure other workers are kept away from identified work areas Physical requirement Stan
32. ls Hoist HRWL HP Piling Rig Jurisdictional design registration Geotechnical reports for ground conditions Risk Assessment Operators Manual Maintenance Reports amp Major Inspections Annual certification for lifting equipment Log Book Certification Competency of operator Page 2 lt ISERT LOGO COMPANY NAME gt Hazardous Substance and Dangerous Goods Register Company Name Project MSDS ISSUE APPROXIMATE QUANTITY TO BE HAZARDOUS DANGEROUS SUBSTANCE col o a YES NO YES NO DATE Not older than 5 years NAME OF SUBSTANCE MANUFACTURER BROUGHT ONTO USED FOR STORED ON SITE ISSUE DATE INSERT DATE 1A SUBCONTRACTOR STATUTORY DECLARATION Statutory Declaration between Insert Subcontractor Name ACN Insert Subcontractor s ACN Subcontractor and Probuild Constructions Aust Pty Ltd ACN 095 250 945 or Monaco Hickey Pty Ltd ACN 144 945 611 Head Contractor in relation to the insert project name project f Click here to enter Full Name of Click here to enter address Declarant am employed by the Subcontractor as Click here to enter address of declarant and am in a position to know the facts declared am the Insert Declarant s Position of the Subcontractor and am authorised by the Subcontractor to make this statutory declaration on its behalf All monies due and payable to the Subcontract
33. ly contained minor level clean up with no Low short term environmental harm Level Likelihood Probability Likely Could happen frequently Moderate Could happen occasionally Unlikely May occur only in exceptional circumstances Risk Class Ranking Job steps Hazards Controls Name of persons responsible for work ISSUE DATE lt INSERT ISSUE DATE gt P2 4 lt INSERT COMPANY LOGO gt Risk Class Job steps Hazards 3 Controls responsible for work Ranking Name of persons ISSUE DATE lt INSERT ISSUE DATE gt P3 4 lt INSERT COMPANY LOGO gt Site Specific Considerations This SWMS has been developed through consultation with our employees and has been read understood and signed by all employees undertaking the works Print Names BLOCK CAPITALS Signature Dates Print Names BLOCK CAPITALS Signatures Dates Review No Initial Date ISSUE DATE lt INSERT ISSUE DATE gt P4 4 Health Safety amp Environmental Form SWMS Review Workplace Name Subcontractor Date of Review Activity Tasks Reviewed b
34. mplates in the absence of a company s own documents It is not intended to remove or surpass a company s own Safety Management System in totality The relevant attachments contained within this document are to be completed and provided to the Site HSE Coordinator or Contract Administrator at least 72 Hours prior to commencement on site DEFINITIONS The Act means the Victorian Occupational Health and Safety Act 2004 The Regulations means the Victorian Occupational Health and Safety Regulations 2007 SWMS means Safe Work Method Statement as defined in Section 5 1 9 of the Victorian OHS Regulations 2007 Fines The dollar value of fines is taken as at the FY10 11 as per the penalty unit published in the Government Gazette RISK MANAGEMENT Risk management is one if the most important activities that a business can undertake to ensure that it reduces the likelihood and consequence of harm within all areas of the business operations Most people automatically undertake basic risk management principles when going about their everyday life for example Question whilst driving a car why do most people stop at a red light Answer Ultimately people make a subconscious decision based on the likelihood and consequence of being injured through being involved in a car accident or penalties incurred as a result of breaking the law For most people the likelihood and consequence of injury or being fined is high and therefore people choo
35. nsibility to ensure that PPE required for specific activities to be undertaken is identified appropriate and used and stored correctly Review outcome HSE Management Plan accepted no amendment oO HSE Management Plan accepted minor amendment L1 HSE Management Plan rejected major amendment O lll MONACO HSE FM 059 1 Health Safety amp Environmental Form Subcontractor Documentation Checklist Corrective action required Contractor Subcontractor Name Signature Date Reviewed by Monaco Hickey Representative Name Signature Date Monaco Hickey Site Manager Site Supervisor Authorisation Name Signature Date lll MONACO HSE FM 059 1 Page 3 lt INSERT LOGO COMPANY NAME gt PROJECT HAZARD IDENTIFICATION BASED ON CONTRACT SCOPE OF WORKS FOR lt lt INSERT PROJECT NAME gt gt The Victorian OHS Regulations Part 5 Construction section 5 1 3 amp Interstate Regulations define High Risk Construction work as being work that involves one or more of the following High Risk Indicate if applicable to scope of works Yes Where there is a risk of a person falling more than 2 metres On telecommunications towers Demolition The removal or likely disturbance of asbestos Structural alterations that require temporary support to prevent collapse A confined space A trench or shaft if the excavated depth is more than 1 5 metres A tunnel The use of explosives
36. ollowing induction Page 1 Health Safety amp Environmental Form Plant Induction Below is a list of items that are required for each piece of plant prior to operation e Scissor Lifts EWP e Excavators Backhoes Bobcats e Risk Assessment e Operators Manual e Maintenance Reports e Log Book e Scissor Lift lt 11M Certification Competency of operator e EWP gt 11M HRWL WP Forklift Telescopic Forklift Risk Assessment Operators Manual Maintenance Reports Log Book Fire Extinguisher Seat Belt Flashing light Forward amp Reverse Beeper SWL chart and Compliance plates for all attachments Forklift HRWL LF e Telescopic Forklift gt 3T HRWL CN Suspended Scaffold Swing Stage Jurisdictional design registration Risk Assessment Operators Manual Maintenance Reports Log Book Fire Extinguisher Handover certificate Structural Engineering calculations Persons conducting works within the swing stage are to be inducted into the safe use Ill Monaco Risk Assessment Operators Manual Maintenance Reports Log Book Fire Extinguisher Seat Belt Flashing light Forward amp Reverse Beeper Burst valve on gt 1T excavator ROPS amp FOPS Certification Competency of operator Man and Materials Hoist Jurisdictional design registration Risk Assessment Operators Manual Maintenance Reports amp Major Inspections Log Book Hand over certificate Materials Hoist HRWL HM Man and Materia
37. onnel hoist Personnel hoist may require manual opening closing of doors Other Description of task Physical requirement ISSUE DATE lt INSERT DATE gt P2 2 Health Safety amp Environmental Form Plant Induction This form to be used for all plant excluding mobile cranes and truck mounted concrete pump the specific mobile crane and truck mounted concrete pump induction forms are to be used Workplace Name Plant Make Plant Owner Supplier Year of Manufacture Serial No Yes No Risk Assessment Complete Logbook in place and legible Guarding is in place including ROPS Proof of Competency obtained if required Items to be actioned before use Subconiractor Plant Supplier to complete hereby declare that the plant outlined above is fit for purpose and has been serviced and maintained by a competent person in accordance with the manufacturers recommendations Name Company Date Signature MONACO HICKEY PLANT INDUCTION Company Subcontractor Plant Model Contact No Authority Registration No if applicable Plant Type Yes No Horn reverse beeper and flashing light is in place if applicable Maintenance Records Available 10 Year Inspection Complete if applicable All required PPE is available By Whom Completed Y N Date Monaco Hickey Review Reviewed By Date Signature Plant registration card is to be issued f
38. or for work under the Subcontract forming part of the last Progress Claim have been paid All wages and allowances including payments in satisfaction of all statutory requirements and the requirements of any applicable industrial award approved superannuation schemes redundancy payments premiums for workers compensation or similar schemes due and payable at the date of this declaration to employees of the Subcontractor in respect of their employment on work under the Subcontract have been paid All monies due and payable excluding cash retentions to the Subcontractor s subcontractors consultants and suppliers of goods amp services engaged on work under the Subcontract in respect of invoices rendered up until and forming part of the last Progress Claim have been paid to them The Subcontractor is not in breach of its obligations under the Subcontract The Subcontractor is solvent and has not traded insolvent during the period of this declaration Where the Subcontract has not yet been executed by the Subcontractor the Subcontractor acknowledges and agrees to the Subcontract terms and conditions offered by the Head Contractor and agrees those terms and conditions apply as if the Subcontract had been executed and To the best of my knowledge and after proper enquiry at the date of this declaration no circumstances exist which may give rise to variation claims or additional costs under the Subcontract other than those previously s
39. ot required to notify the Authority if the employer or self employed person is the only person injured or otherwise harmed or exposed to risk as described in section 37 by the incident 3 Within 48 hours after being required to notify the Authority the employer or self employed person must also give the Authority a written record of the incident in the form approved in writing by the Authority 4 The employer or self employed person must keep a copy of the record for at least 5 years and make a copy of the record available for inspection by a an inspector or b a person or a representative of a person injured in the incident or whose health or safety was exposed to immediate risk by the incident or c a representative of a person whose death was caused by the incident or d in the case only of an employer i if any of the employees of the employer are members of a designated work group a health and safety representative for the designated work group or ii the members of each health and safety committee if any established by the employer 5 An employer or self employed person who contravenes sub section 1 3 or 4 is guilty of an offence and liable to a fine not exceeding a in the case of a natural person 60 penalty units or b in the case of a body corporate 300 penalty units PLAIN ENGLISH INTERPRETATION As soon as an incident falls into the categories listed as being notifiable WorkSafe i
40. out first obtaining a plant induction and e All lifting equipment is to be inspected prior to each use A copy of Monaco Hickey s Common Plant amp Equipment List and Project Plant Register are provided in the Subcontractor Documentation Pack O Induction Number Date Inducted UA s Lu 5 sy 3 Company Name c Qi c7 isi 2r amp Project Name Pies E 8 0 HAZARDOUS SUBSTANCES AND DANGEROUS GOODS Hazardous Substances and Dangerous Goods have significant potential to cause harm to people property and the environment if not managed appropriately The following outlines definitions legal requirements and Monaco Hickey requirements for bringing and or storing Hazardous Substances amp Dangerous Goods on site 8 1 DEFINITIONS Dangerous goods are classified on the basis of immediate physical or chemical hazards such as fire explosion corrosion and toxicity that may affect life health property or the environment Hazardous substances are classified only on the basis of immediate or long term health effects 8 2 LEGAL REQUIREMENTS Section 404 Identification of Hazards of the Victorian Dangerous Goods Storage and Handling Regulations 2000 states that 1 An occupier of premises where dangerous goods are stored and handled must ensure that any hazard associated with the storage and handling of dangerous goods at the premises is identified having regard to the state of knowledge of the hazar
41. rk related injury on a Monaco Hickey Project the following is to occur e A Senior Manager that is responsible for the injured worker is to attend site to meet with Monaco Hickey s Project Manager in order to complete Monaco Hickey s Lost Time Injury Review Form e Following the meeting with Monaco Hickey s management the injured workers management is to ensure that all outcomes agreed to during the LTI review process are adhered to INCIDENTS THAT REQUIRE STATUTORY NOTIFICATION Victorian Legislation identifies various types of incidents that require notification to WorkSafe Victoria The purpose of notification is to ensure that incidents that are deemed serious receive a thorough investigation to prevent the possibility of re occurrence Section 37 of the Act identifies the following as being incidents that require statutory notification 10 16 e the death of a person or e a person requiring medical treatment within 48 hours of exposure to a substance or e a person requiring immediate treatment as an in patient in a hospital or e a person requiring immediate medical treatment for i theamputation of any part of his or her body or ii a serious head injury or iii a serious eye injury or iv the separation of his or her skin from an underlying tissue such as de gloving or scalping or v electric shock or vi a spinal injury or vii the loss of a bodily function or viii serious lacerations or e any oth
42. s Debts Act B ABN if applicable 1897 in respect of work or material supplied in respect of the Project have been paid 4 Attached is a declaration from each person to whom the Consultant has subcontracted work in relation to insert position the Project as referred to in section 13 of the Contractors Debts Act 1897 confirming that all wages of workers f title of Declarant employed by and all materials and works supplied by such subcontractor have been paid 5 am not aware of anything that would contradict the statements made in the statutory declarations 6 The period of the Agreement covered by this declaration and the attached declarations is from f Insert the relevant to payment period The Consultant is not under any law insolvent or unable to pay its debts as and when they fall due And make this solemn declaration by virtue of the provisions of the Statutory Declarations Act 1959 ACT Declared at place where declaration made on date of declaration by Signature of person making declaration before me Justice of the Peace Solicitor of the Supreme Court of the Australian Capital Territory or other person legally authorised to witness the making of a declaration under the Statutory Declarations Act 1959 ACT or where the declaration is made outside the Australian Capital Territory any person having authority to witness the making of a declaration in that place A person having authority to witne
43. s to be notified immediately The easiest way to do this is via the WorkSafe incident notification hotline Within 48 Hours a copy of WorkSafe s Incident Notification Form is to be completed and sent to WorkSafe Failure to notify WorkSafe could lead to fines of up to 36 000 HSE MP 105 2 ISSUE DATE 8 April 2014 12 16 6 0 IllimoNAco HICKEY 5 4 3 MONACO HICKEY EXPECTATIONS FOR INCIDENT NOTIFICATION AND SCENE PRESERVATION If you are working on a Monaco Hickey site our expectation is that you contact either the Project HSE Coordinator or the Project Manager as soon as you become aware of the incident Monaco Hickey is able to help with the notification process to WorkSafe and will conduct an internal investigation into the incident to determine root causes and assist in the prevention of re occurrence 5 4 4 NEAR MISS INCIDENTS Near miss incidents that had the potential to cause serious injury structural damage injury to members of the general public or property damage must be reported to Monaco Hickey s Management immediately Monaco Hickey s management will undertake an incident investigation and in certain circumstances the near miss incident may require notification to WorkSafe as per the notification requirements in S37 of the Act RETURN TO WORK It is the responsibility of all companies businesses that have a payroll exceeding 1 000 000 to ensure that they have an appropriate Return to Work progr
44. se to stop rather than go straight ahead In a business application risk management principles are often applied to areas such as Occupational Health and Safety Management Health Safety amp Environmental e Environmental Management e Quality Management e Financial Management and e Business Reputation Management For the purpose of this document the risk management principles will be applied to Environmental Health and Safety HSE 4 16 3 1 HSE MP 105 2 ISSUE DATE 8 April 2014 lI MONACO HICKEY The basic risk management process involves e Identification of potential hazards e Assessing the likelihood and consequence of the risk e Determining risk controls to be implemented and e Assessing implemented controls for effectiveness This process is completed through the development of Safe Work Method Statements SWMS as required throughout the life of the job CONDUCTING A PRELIMINARY HAZARD IDENTIFICATION BASED ON YOUR SCOPE OF WORKS A preliminary hazard identification that is based on your scope of works will assist you with identifying key areas of risk prior to task commencement The benefits to you as a subcontractor are as follows e Reduce the likelihood of injury with the potential to impact on workers compensation premiums e It will assist in minimising potential disruption to work through absenteeism caused by injury e It highlights areas of increased risk to your workers and oth
45. ss the making of a declaration Jurisdiction Applicable Act may include Correct wording Declarations can be made before the following persons New South Wales Oaths Act 1900 And make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths Act 1900 e A justice of the peace e A solicitor holding a current practising certificate e A notary public Queensland Oaths Act 1867 And make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths Act 1867 e A justice of the peace A barrister solicitor or conveyancer qualified under the law of the Commonwealth or another state e A notary public A commissioner for declarations South Australia Oaths Act 1936 And make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths Act 1936 e A justice of the peace e Alawyer Tasmania Oaths Act 2001 make this solemn e A justice of the peace declaration under the e A lawyer Oaths Act 2001 e A notary public e Any other person listed in Schedule 2 to the Statutory Declarations Regulations 1993 Cth Victoria Evidence Act 1958 acknowledge that this e A justice of the peace declaration is true and e A public notary correct and make it in the P A lawyer belief
46. ubmitted or notified to the Head Contractor as required under the Subcontract ACKNOWLEDGE that this declaration is true and correct and make it with the understanding and belief that a person who makes a false declaration is liable to the penalties of perjury Declarant DECLARED before meal 3er Poit ete e tete ce ete cem ete mete ted i e ee ie e t MS iawn tes Cay Of icu tts SUBCONTRACTOR DECLARATION NSW ONLY SUBCONTRACTOR S STATEMENT REGARDING WORKER S COMPENSATION PAYROLL TAX AND REMUNERATION Note1 see back of form For the purposes of this Statement a subcontractor is a person or other legal entity that has entered into a contract with a principal contractor to carry out work This Statement must be signed by a subcontractor or by a person who is authorised or held out as being authorised to sign the statement by the subcontractor referred to in any of s175B Workers Compensation Act 1987 Schedule 2 Part 5 Payroll Tax Act 2007 and s127 Industrial Relations Act 1996 where the subcontractor has employed or engaged workers or subcontractors during the period of the contract to which the form applies under the relevant Act s The signed Statement is to be submitted to the relevant principal contractor SUBCONTRACTOR S STATEMENT Refer to the back of this form for Notes period of Statement retention and Offences under various Acts Subcontractor ABN Business name Of Address of sub
47. y name Signature a Name and registered office ABN ACN and YesL Nol contact details of the company that shall undertake the work b Signed dated by person who has prepared and YesL NoL approved the SWMS for implementation monitoring and compliance c Description of specific work tasks and how they YesL NoL are to be carried out including workplace specific considerations being taken into account during the development of the SWMS d Work activities assessed as having significant YesL Nol health and safety hazards and environment impacts e g High Risk Work Tasks e Identifies workplace specific HSE YesL No hazards impacts relevant to all work activities including High Risk Work Tasks f Are control measures outlined in the SWMS YesL NoL relevant and in keeping with the hierarchy of control g Identify the workplace specific environment impacts relevant to all work activities C Waste bulk prescribed hazardous licence to YesL Nol discharge concrete paint or other washout O Air quality dust emissions odours or YesL Nol stockpiles O Noise location of nearest sensitive receiver amp Yes Nol noise levels vs background levels C Water quality slurry nearby drain inlets YesL Nol sediment laden run off quality of any discharge e g pH solids turbidity O Flora amp Fauna protected species habitats YesL Nol on adjacent to the workplace O Soil chemical stora
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