Worker & Contractor WHS Record Form

SECTION 1. Introduction, Instruction

Relax - this isn't a test
Filling in this form helps you and your client meet WHS duties.

Please complete as much as you can to the end of the form, then 'Submit'. This helps us respond with any questions/ assistance, Thank you.

Question Title

* Company/ Organisation that you work for/ represent:

Question Title

* Your Contact Information

First Name

Surname

Position

Phone Number

Question Title

* I will be undertaking work for:

Local Government Organisations (Shires)

Private Sector (Business/ Companies)

This Form provides Worker and Contractor Work health & Safety (WHS) Record System instruction and consultation, requests information, document uploads and declarations.

PRINCIPALS: Contractor, Sub Contractor, Organisations and Sole Trader Responsible Person/s - Complete sections 1 to 9 - MUST READ SECTION 5-9 INSTRUCTIONS BELOW

WORKERS: Employees, Volunteers, Work Experience - Complete sections 1 to 4

A PCBU Representative will provide Site Specific instructions regarding Hazards and other relevant information via the Work Site WHS Induction prior to commencing work.

Emergency Preparedness & Incident Report with contact numbers and Policies & Procedures Manual for the specific PCBU that you are undertaking work for are available on the following link. https://www.promptsafetysolutions.com/worker-whs-record-system-lg

DEFINITIONS
Under the Work Health and Safety Act 2020, work relationships are defined as:

“Worker” A person who carries out work in any capacity for a PCBU (An Employee, Contractor, Work Experience person or Volunteer).
“PCBU” Person Conducting a Business or Undertaking. For the purpose of this document the Entity you are Working for is the PCBU.

Contractors - Under the WHS Act, are defined as a “Worker” and can also be defined as a “PCBU” as they have a primary duty of care to ensure the health and safety of their Workers while they are at work. In this context, 'Workers' are those engaged, or caused to be engaged by the person (Contractor or Sole Trader) and those whose activities in carrying out the work are influenced or directed by the person.

WHS RECORD INFORMATION
The information that you provide by completing this Worker WHS Record Form, will be made available to PCBU's who contract Prompt Safety Solutions Worker WHS Record System. VIEW PRIVACY POLICY

Specific instructions regarding Hazards and other relevant information will be conveyed by the PCBU Authorised Person via the Work Site WHS Induction, Inspection & Consultation Checksheet for Workers on arrival to site and prior to commencing work.

If you have any questions, please contact Prompt Safety Solutions by email: wm@promptsafetysolutions.com or phone: 0427 616 837 for guidance regarding this Worker WHS Record System.