SECTION 1. Introduction, Instruction

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.
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.

The information that you provide by completing this Worker WHS Record Form, will be made available to Local Governments (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: or phone: 0427 616 837 for guidance regarding this Worker WHS Record System.

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Contractor, Sub Contractor, Organisations and Sole Trader Responsible Person/s

As a Contractor/ Sub-Contractor/ Sole Trader/ Organisation Principal providing works or services to participating PCBU's, you must undertake this following WHS Record Form on behalf of your Company or Organisation.

If you engage Sub-Contractors, you must also send this WHS Record Form document to the Sub Contractor Principal or representative to complete before they commence works.

Risk Assessment
You must provide the PCBU with a Risk Assessment relevant to the works or activity to be undertaken.

You must fill in all Declarations including:
  • Section 5. Risk Assessment Declaration
  • Section 6. Verification of Competency Declaration
  • Section 7. Insurance Declaration
  • Section 7. Vehicle Plant & Equipment Insurance & Licence Declaration
  • Section 8. Hazardous Substances Declaration
  • Section 9. Safety Management System Declaration
You must provide the PCBU with relevant insurances for your Business or Organisation structure for the works or activity to be undertaken, including:
  • Public Liability Insurance Certificate of Currency
  • Professional Indemnity Insurance Certificate of Currency (If applicable)
  • Workers Compensation Insurance Certificate of Currency (If applicable)
  • (Sole Traders) Personal Accident Insurance Certificate of Currency or Income Protection (If applicable)
    Plant - Motor Vehicle/s Insurance (If used on the job)

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* Local Government/s you are undertaking work for:

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