Contractor Induction
Contractor Induction
Contractor Induction
Health Information
Circle as
appropriate
CONTRACTOR INDUCTION TEMPLATE
Do you know of any health problems which could affect your work? Y/N
Are you currently taking any medication / undergoing any treatment that may affect your work? Y/N
Do you suffer from any condition that the first aiders should be aware of such as asthma,
Y/N
diabetes, epilepsy or a heart condition etc? If YES, please provide details below.
Do you suffer from hearing loss or require a hearing aid to assist you to hear fully? Y/N
Do you suffer from any back problems or upper limb disorders which may be aggravated by your
Y/N
work?
If you have answered YES to any of the above questions, please give full details, and any other information
which you think we should be aware of below. If your circumstances change whilst you are working on site,
please notify the Site Manager.
Detail:
If any answers are ‘Yes’ then please file separately and securely so records can be found in case of emergency.
Name: Relationship:
Telephone Number:
Confirmation:
I can confirm that I have understood the information, instructions & site rules delivered during the site induction,
as detailed on this form.
I fully understand and will work within the limits of my company risk assessment and method statements, I will
wear all PPE stipulated by the Subcontractor Health, Safety & Environmental code of conduct, site rules and
my company RAMS.
I will abide by the requirements of the Health and Safety at Work Act and that I am responsible for the health &
safety of myself and others that may be affected by my actions.
I confirm that by signing this induction form I consent to Avondale carrying out drugs and alcohol testing should
the site manager feel it is appropriate.
Name of Inductee:
Signature of Inductee:
Company:
I am over 18: Y / N (Circle as appropriate)
Date:
Inductor:
Inductors Signature: