Document Name: KALMAR-FORM-12
Revision: 3.1
Revision Date: 16/03/2020
Next Revision Date: 16/03/2021
Kalmar Australia
Level 3, Building/12 Lord St, Botany NSW
2019 ABN:88 613 156 380
Please fill in the information below as clearly as possible site induction number: ___________________
Site Address: 400 Moorebank Avenue
Project Number: 6/FI05733
Your Name:
Date:
Trade / Type of work:
Company:
Mobile Number:
DOB:
Supervisors Name:
Supervisors Mobile:
Emergency Contact Name:
Emergency Contact Number:
Medical Conditions:
Medications:
Qualifications
High risk work licenses are required to undertake the following: (cranes, scaffolding, dogging, rigging, forklift, hoist, vehicle loading
cranes) must provide a copy to Kalmar staff. Please list your tickets below.
Classification:
Card Number:
Classification:
Card Number:
Induction Checklist
Initial
(SWMS) Safe Work Method Statements / SOPs: Must be reviewed, approved and signed prior to commencing work.
Workers must follow the controls outlined in these documents or understand they could be removed from site.
Permits Are issued for works such as; confined spaces, deep excavations, overhead powerlines, pressurised gas, welding
(electrical/gas), thermal/oxy cutting, spark producing operations, dual crane lifts, working at heights.
MSDS - Material Safety Data Sheet are compulsory for trades using dangerous/hazardous chemicals applicable trades
must provide relevant SDS to Kalmar. SDS are located in the induction room or other specified location.
Mandatory PPE (personal protective equipment) 3-point warning system applies (hard hat, Steel cap boots, hivis vest,
safety glasses, long pants, long sleeve shirt. PPE free zone does not require site specific PPE.
Daily Sign in and Sign out register is mandatory for all workers and visitors on site.
Site Noticeboard displays the following: photos of site management team, safety committee members, evacuation plan,
committee inspection reports and other relevant WHS information.
Electrical Testing and Tagging is required on all electrical requiring a power socket. Power tools and other appliances
within the work area must be tagged 3 monthly and periodically checked for damage. 12 monthly for PPE free zone items
and office appliances.
Work Platform 450mm wide trestles and platform ladders are only allowed on site (3-point contact). If elevated and a
ladder would raise you above a handrail or not provide sufficient protection a snap scaffold or other should be used.
Safe Access and Egress must be maintained always for fire evacuation purposes and safety issues. If material cannot be
removed from level it must be swept up/out of the way until bins are provided.
Housekeeping clean your debris progressively dispose in the bins provided or heap piles to maintain clear access.
Plant – I understand prior to commencing work using mobile plant I will complete a Kalmar competency evaluation and
plant must be inducted on site prior to use
Injuries and Near Miss incidents must be reported to the site management team and first aider if applicable.
Scaffolding can only be modified by a licensed scaffolder do not alter any components such as removal of scaffold ties or
planks will result in immediate removal off site.
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Document Name: KALMAR-FORM-12
Revision: 3.1
Revision Date: 16/03/2020
Next Revision Date: 16/03/2021
Kalmar Australia
Level 3, Building/12 Lord St, Botany NSW
2019 ABN:88 613 156 380
Code of Conduct: Unacceptable behaviour on site relates to but is not limited to comments such as; race, colour, religion, bullying,
fighting, verbal threats, insults, jokes, disability, sexual orientation, sexual harassment/innuendos to same or opposite sex will not
be tolerated on Kalmar sites.
Inductor Name:
Date:
Inductor has photocopied photo ID & other competencies
Instructions: If you have any questions do not hesitate to ask the person performing the induction. Please circle the
correct answer and your initials on the line next to your circled answer.
Induction quiz questions
1 What are the site start/finish times Monday to Friday and Saturday?
7:00am – 5:00pm: _________ 8:00am – 1:00pm: _________
7:00am – 3:30pm: _________ 7:30am – 5:30pm: _________
2. Do you have more than 12 months of industry experience?
Yes: _________ No: _________ (if not see Kalmar management)
3. What do you do if you are injured at work?
Notify your supervisor: _________ Notify safety advisor: _________ Seek First Aid: _________ All three: _________
4. Where is the emergency assembly point located? ________________________________
5. How frequently should your leads and power tools be tested and tagged on Kalmar sites?
Monthly: _________ Yearly: _________ 6 Monthly: _________ 3 Monthly: _________
6 What mandatory PPE is required in the work area at all times?
Hardhat, hi-vis, steel cap boots: _________ Thongs, hardhat: _________
hard hat, Steel cap boots, hivis vest, safety glasses, long pants, long sleeve shirt: _________
Doesn’t apply to me: _________
I __________________________________ acknowledge all the above site safety rules and site safety
policy located on the notice board near the site office and will follow all these rules and any other safety
requests made by Kalmar staff. Unable to follow these rules and directs will result in reinduction at
employers cost or immediate removal from site.
Signature: _______________________________________
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