Visitors Induction Form
Form number
Version Number
Date of issue
Farm Name:
Organisation:
Reason for visit:
Time of arrival:
S 08
01
30/05/14
Visitors Name:
Date of Visit:
Number of people:
Time leaving:
Visitors Contact Details:
Address:
Phone:
Vehicle Licence No:
Emergency Contact:
Emergency Number:

Visitor Declaration …… I acknowledge that;
Landcorp has taken all practicable steps to advise me of all known hazards I would not reasonably expect to find on
the property and I shall comply with all safety instructions given by Landcorp staff.
Landcorp is not liable for any injury loss or damage arising out of my use of and/or access to Landcorp’s property
arising directly or indirectly from any carelessness, breach of statutory or other lawful duty, negligence or fault
whatsoever on Landcorp’s part.
Landcorp is not guaranteeing the possible results of the activity to me but rather granting permission to use the
land for the above purpose. Furthermore I will be responsible for my own safety and acknowledge my need to be
prepared for unforeseen hazards / activities that may occur while on this farm such as adverse weather, stock
activity and other land users.
By entering this Landcorp farm I accept responsibility and liability for any damage or loss caused to Landcorp
Farming Ltd by my actions or omissions (e.g. failure to leave gates as they are found).
Where my activity involves the use of a firearm (e.g. hunting), I hold a current firearms licence which has been
sighted by the Farm Manager. (Licence Number: ___________________________________________________ .)
Any concerns from Landcorp staff regarding the safety of my activities may result in a requirement for me to leave
the farm immediately.
Applicable to groups holding events on Landcorp farms:
Indemnity to Landcorp in Relation to Events
My organisation shall indemnify Landcorp against any legal action, suit, proceedings, liability, claim, demand, injury
loss, harm, damage or expense (including legal fees and disbursements) caused by our negligence or fault or that of
persons under our control relating to our activities on the farm.
Public Liability Insurance
This section needs to be completed by any person or organisation who is holding an event on farm. (e.g. Horse Trek, Field day etc)
The Licensee shall hold not less than $5 Million public liability insurance and not less than $500,000.00 insured coverage under the
Forest and Rural Fires Act 1977.
Insurance Details:
Please note: By signing this the “visitor” confirms they have the authority to act on behalf of the company they are representing.
Visitor Signature:
Visitors Name:
Farm Manager Signature:
Date: