ARN Induction - ARN Projects

ARN
INCUDCTION FORM

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Personal Information

Full Name *

Contact Number *

Email Address *

Trade / Occupation *

Address Line 1 *

City / Town *

County *

Post Code *

Health Statement

Emergency Contact Name *

Emergency Contact Number *

Do you suffer from any of the following conditions? *

None
Asthma
Epilepsy
Diabetes

Please specify

Joint problems (neck, back, hip, knee etc) *

Please specify

Do you take any regular medication? *

Please provide more details on your regular medication

Do you take any medication which may cause a risk to your function on site? *

Please provide more details on your medication which may cause a risk

Do you have any other medical conditions which may affect your functions on site? *

Please provide more details on your medical conditions

Have you sustained any accidents in a work place during the last three years which you had to enter into an accident book? *

Please provide more details on your accidents

Please state here how many times you had to report an accident and record it into the accident book in any work place in the last three years *

If you have had an accident in the work place in the last three years please give details here as to the nature of the accident

CSCS Card

Do you hold any type of current CSCS card? *

Did you show it to the person conducting this induction? *

Is the card suitable for the task you are about to carry out on this site? *

Did you pass a health and safety test as part of your CSCS card award in the last two years but no more than two years? *

Risk Assessments and Safety Procedures

Have you received, read and understood the RISK ASSESSMENTS and SAFETY METHOD STATEMENT and also the COSHH assessments for what you will be doing on this site?

Have you signed to state that you have?

Can you prove it to us?

Do you understand the content?

Do you agree to fulfil the method of work as mentioned in your company statement of work and any changes to this method will need to be discussed and agreed with your supervisor and the site manager on this site first?

Do you agree to the above? *

Have you received, read, and understood your Employer Safety Policy, and are you happy that the way you will need to operate on-site under the guidance of your supervisor is safe? *

Are you aware of the Emergency Procedures and Accident/Emergency Reporting procedures on this site? All the documents mentioned are on the wall next to you, please read them! *

Are you aware as to who the first aiders are on site and do you know that if you or others are in need of a first aid you will need to alert the site manager directly or indirectly, do you know how to report an accident,? *

Do you know the location of the nearest hospital and are you now aware that there is a map with this location of the map in the canteen, take it down and use it in an emergency? *

Site Rules and Working Hours

Are you aware that when entering the site, you will not allow other persons to enter the site with you? *

Do you know the location of the site toilets? *

Do you know that the site working hours are: Mon- Fri, 0730-1730 and no work should take place on site outside the time listed unless agreed with the site manager first *

You need to obtain a written instruction for it and it will be your own responsibility to inform the site manager that you are still working after 1730 and you will need to ask your supervisor to clear this matter first! *

Tool Box Talks and Waste Disposal

Are you aware that you will be asked to attend Tool Box Talks regularly? *

You know NOT to use site skips for any items marked as harmful or hazardous items or containers. *

Working at Heights and Ladder Use

Are you aware that before working at heights that are likely to cause an injury or using Alloy Towers and/or Ladders, you must inform the Site Manager first!

Don’t remove any edge protection, fall arrest or fall prevention system on site

Always ensure that gates and other safety protection to prevent falls from height are kept locked.

Do not work at height unless there is a suitable work platform, fall prevention or fall arrest system in place – and you are trained to use them

Only essential short duration work permitted off ladders

Always assess if there is a safer way of doing the work.

Ladder in to be tied at the top and must be leaning at an angle of 1:4 or 75o (1m horizontal to 4m vertical)

Only use class 1 Industrial Heavy Duty ladders and stepladders are permitted on this site. Class 2 and 3 are not allowed.

Do not work off the top step of a stepladder, or the top few rungs of a ladder.

Don’t use makeshift ladders or access equipment – only use tested, suitable access equipment.

All ladders must be in good condition – no bent or damaged rungs or stiles

Do you agree with our working at heights and ladder use policy above? *

Storage, Fire Safety, and Site Management

All materials should be stored in an orderly manner and in designated areas if you are unsure please check with your supervisor or the site manager. *

Stack materials safely, and avoid over-stacking *

Don’t block traffic routes or emergency routes with any materials. *

Are you aware of the Site Manager and Site Safety Supervisor? *

Do you know where the fire points and assembly point are located? *

Are you aware of the fire plan, where fire points are located and do you know that the assembly point is next to the hand recognition unit and if you hear the fire alarm or bells you need to leave your work area and make your way to the hand recognition cabin ASAP? *

Are you aware that the Principal Contractor on this site is A.R.N Projects? *

COSHH and Hazardous Substances

Before using any Hazardous Substances you will need to check the COSHH ASSESSMENT PROVIDED All hazardous substances (those that are flammable, explosive, corrosive, harmful or irritant) must be accompanied by a COSHH assessment.

Many substances can have an adverse effect on your health, and on the health of others. Always ensure that you know what you are using and how to use it safely, do not discard any empty or half empty packing with any hazardous substances into the site skip, ask your supervisor to remove them from site

Hazardous substances must be stored appropriately or removed from site when not in use. You need to know how to do this.

Do you agree with our COSHH and Hazardous Substance policy above? *

Hot Work

I am aware that before I carry out any work involving heat, flames, sparks or fire I will fill Hot Work Permit on a daily basis, If I will fail to do so I will face the possibility of being dismissed from this site, Are you also aware that a fire watch of at least one hour will need to take place after you have finished your hot work and before you have left site for the day, you are aware that it is not the responsibility of the site management to carry this inspection for you and any damage to property as a result of fire or sparks or heat will be charged to you and/or your employer regardless how large or small it is, it is also your own responsibility to protect your area from any damage.

Do you agree with our hot work policy above? *

PPE

I am aware that a failure to use the listed below will invalidate any claim I may have in the future in case of any injury and I am aware that I have to use PPE at all times (Unless otherwise agreed with the Site Managers first) which is relevant to the task I will carry on the site in accordance with safety rules and as set in my employer method statement for the task I will carry and in addition:

I will use ear protection eye protection and dust masks when and where needed and I will use my hard hat at all times.

Head Protection with a valid date of not more than three years and no crack of faults or dents

High visibility clothing to the top part of the body

Protective footwear with steel cap and steel midsole

I will wear gloves if required and as specified in the risk assessment and method statement relevant to the task I am performing

Do you agree with our PPE policy above? *

Will you be using power tools that generate dust? *

Will you be wearing a dust mask? *

Have you been face fit tested for the type of dust mask you are using *

Power Tools and Vehicles

Only use battery powered or 110V power tools on site unless you have a detailed risk assessment and have agreement from the site manager to use 240v and above. Always ensure that equipment is in good condition – power tools need to be PAT tested every 3 months

Ensure that you visually inspect all tools before you use them for any signs of loose wiring or damage.

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Do you agree to our power tools policy above? *

Are you aware that any vehicles which are left in the car park/on the road left at the owner own risk *

We do not provide insurance for any parked vehicles and once the car park is full you will be obliged to find an alternative car parking solution and when car park is full you may not be able to use your vehicle during the day, if you need to use your vehicle during the day you will be advised to leave your vehicle outside the site car park. *

Excavations

Keep away from the edge of any excavation – you could easily slip or trip towards an open edge, or in the case of ground excavation the ground could give way under you

If you need to access an excavation use appropriate access (such as stairwell, ramp or tied ladder). DO NOT climb down the sides of the excavation.

Remember that all excavations over 1m depth on this site need to be shored or battered back to at least 45o from vertical. Excavations shallower than 1 m must be safe to access. If in doubt, these also need to be shored.

Do not operate plant close to open excavations

Do you agree to our excavations policy above? *

Scaffolding

No alterations to be made to scaffolding at all without prior agreement with site manager,
Any changes will be deemed as a major breach of safety.
Do report any faults with the scaffolding to the site manager and stop your work in that area until the matter is resolved.
Make sure that the loading gates are closed at all times.
Do not move any ladders.
Don’t modify any scaffolding unless you are a scaffolder (proof of competence required).
Don’t access scaffolding unless it is necessary.
Once on the scaffold, do not lean over any edge protection nor open any loading bay gate unless it is part of your work to do so.
Even then only open the gate for the immediate loading or unloading time - and the gate must be shut immediately afterwards.
Access scaffolding via secured access stairwells/ladders.

Do you agree to our scaffolding policy above? *

Plant and Equipment

Do not use any rollers, wheeled or tracked plant or any other plant unless you have shown your operator card to the site manager first. Do not leave any keys in the plant when not in use. Use safety pins at all times.

You may be asked to leave site unless you are using the safety pins for the quick hitch lock for any excavator buckets.

Don’t stand next to or at the rear of plant – the operator may not be aware that you are there

If you doubt the driver has seen you, retreat to a safe distance, stop, try and grab the driver’s attention (e.g. by waving), and await the driver’s confirmation that they have seen you – only then proceed with caution.

If you are operating plant and machinery, carry out necessary checks and inspections before use and all weekly inspections.

Always use the seatbelt provided

Do you agree to our plant and equipment policy above? *

Prohibited Activities and Site Conduct

Are you aware halogen lighting is not allowed on-site? *

Are you aware that alcohol, drugs, and anyone under the influence are prohibited? *

I agree to no horseplay or dangerous practical jokes. *

Fencing, Smoking, and Deliveries

Are you aware that no part of the site hoardings will be removed, moved or altered, clips opened or removed or support and feet removed unless the site manager has allowed you to do so? *

Only smoke in designated smoking areas. *

You will allow no deliveries before 07:00. *

Safety Compliance and Reporting

Are you aware that Site Managers will dismiss you for safety rule non-compliance? *

Are you aware of the red and amber card system and the consequences of non-compliance? *

Report all spillages immediately. *

Additional Specific Tasks

Are you aware that all sub-contractors need to have a foreman or supervisor on site at all times? *

You need to be aware who the foreman is at all times as nominated by your employer, it may be you if you are the only one on site. *

Are you aware that no radios are to be used on site at any time? *

Crane operators, have you seen the lifting plan and provided proof of lifting tests? *

Are you aware of CCTV monitoring on-site? *

Stay safe, follow rules, use proper PPE, and ask for assistance when needed. *

Acknowledgment

Date *

Inductee signature *

Clear Signature

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ARN INCUDCTION FORM