Induction Checklist and Compliance Form

Step 1: Induction Category

Which site(s) will you be attending?

Northern Quarries
Stawell Quarry
Mckenzie Creek Quarry
Wim Mix
Other

If 'Other' is selected, please specify

 

Which category best describes your purpose of visit? -- Select one On Road Truck Driver Industry Consultant/Service Provider Contractor Employee

Step 2: Enter your personal details below

First Name

Last Name

Mobile Phone

Email (optional)

Step 3: Your company name

Trading Name

Step 4: Licences, Competencies and Trade Certificates

Competencies

Have you completed the CMPA Work Safely Training? Yes      No

If Yes, Year Completed:

Have you completed Construction Induction Training
(Red Card)? Yes      No

If Yes, Certificate/Card No:

 

Licenses

If operating a vehicle on site, please fill in the fields below. If On Road Truck Driver was selected in Step 1 this information is compulsory

Drivers License Number

Drivers License Category

 

Trade Certificates

List all trade certificates, competency cards or licences that you hold which are relevant to the tasks you will be completing on site (record Certificate/ License Type and number)

 

Step 5: Confirmation of Understanding Induction Presentation and Induction Test

By placing a tick in the check box below you acknowledge that:

1. All details given on this from are true and correct
2. You have watched and understood the Conundrum Holdings Site Induction Video
3. You have personally completed the Conundrum Holdings Site Induction Test [CH 4.iv.0231]
4. You agree to abide by all instructions presented during the induction video and understand your responsibilities to comply with all matters raised within this site induction and all relevant legislation whilst on any Conundrum Work Site, and
5. Lapsing, cancellation or termination of any of the above nominated license/qualifications requires notification to Conundrum Holdings Pty Ltd

I have read and accept the terms and agreements above