Contractor WHS Declaration

Please indicate “X” in the YES, NO or N/A to the statements on the NEXT PAGE

Indicate in the checklist on the next page the items you have (YES), do not have (NO), or those that are not applicable (N/A).

Please note: some of your responses require mandatory documentation as part of your adherence to the WHS Act 2011 & WHS & OHS Legalisations. If you need to develop a policy, refer to the SMS Knowledge Base for useful templates. This resource will help you meet WHS requirementsand allow you to acknowledge YES to the WHS statements.

Community Select contractors may be required to supply additional evidence to support compliance with the Work Health and Safety requirements. The checklist on page two reflects documentation that would be expected to be supplied under WHS legislation, and may be requested by Community Select or its third party verifier and auditing team.

I understand and agree to supply additional documentation if requested

Business name:

ABN:

I am an authorised representative of this company and declare this information to be true and accurate.

Name of authorised company representative:

Signature of the authorised company representative:

Position of authorised company representative:

Proceed to checklist on next page

Please indicate YES, NO or N/A to the following / YES / NO / N/A
Do you have in place:
  1. A WHS Policy which is actively maintained and reviewed against relevant legislation?

  1. A process to audit, document and monitor your WHS Performance?

  1. A formal environmental policy?

  1. A procedure or assessment that identifies risk and controls hazards?

  1. A skills register that documents existing skills, training needs, licenses and SWMS/JSA training?

  1. An induction process for new employees/workers?

  1. A procedure for engaging with sub contractors?

  1. A safety management system which identifies when supervision is required and how this is implemented?

  1. A process to audit, document and monitor your WHS performance?

  1. A process to actively promote a climate of continuous improvement at your company?

  1. A procedure for the management of incidents and hazard reporting?

  1. An emergency management procedure?

  1. A procedure around the use of personal protective equipment (PPE)?

  1. A policy for the management of fatigue?

  1. A drug and alcohol policy and management procedure?

  1. A procedure for the management of confined space works?

  1. A system that manages hazardous chemical, hazardous substances and dangerous goods?

  1. A procedure for the management of work involving asbestos?

  1. A procedure for the management of dust control, gases and vapours?

  1. A procedure for the management of work carried out on/near Energised Electrical installations or services?

  1. A procedure for the management of hot works?

  1. A procedure for the management of work requiring lock out, tagging and Isolation procedures?

  1. A procedure for the management of work involving noise?

  1. A procedure for work involving plant & equipment?

  1. A procedure for management of working at heights?

  1. A procedure for work involving demolition?

  1. A procedure for work requiring traffic management?

  1. A procedure for the management of work carried out near tunnels, shafts or trenches under construction?

  1. A procedure for the management of work carried out or on chemical, fuel or refrigerant lines?

  1. A procedure for works carried out on or near pressurised gas distribution mains or piping?

  1. A procedure for work involving structural alterations or repairs requiring temporary support to prevent collapse?

  1. A procedure for managing work carried out on a telecommunications tower?

  1. A procedure for tilt-up or precast concrete?