Worker & Contractor WHS Record Form

SECTION 1. Introduction, Instruction

Question Title

* Local Government/s you are undertaking work for:

Shire of Boddington

Shire of Boyup Brook

Shire of Bruce Rock

Shire of Chittering

Shire of Cue

Shire of Dumbleyung

Shire of Goomalling

Shire of Katanning

Shire of Kondinin

Shire of Kulin

Shire of Lake Grace

Shire of Merredin

Shire of Mukinbudin

Shire of Narembeen

Shire of Pingelly

Shire of Sandstone

Shire of Wagin

Shire of Waroona

Shire of Woodanilling

Shire of Wyalkatchem

Shire of Yalgoo

Additional Local Governments (If relevant)

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 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: wm@promptsafetysolutions.com or phone: 0427 616 837 for guidance regarding this Worker WHS Record System.

Question Title

SECTION 5-9 INSTRUCTIONS FOR PRINCIPALS
Contractor, Sub Contractor, Organisations and Sole Trader Responsible Person/s

NOT APPLICABLE TO DIRECT PCBU EMPLOYEES, VOLUNTEERS, WORK EXPERIENCE

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.

Declarations
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

Insurances
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)