| Business (PCBU) | [Business name] |
|---|---|
| Site | [Site] |
| Worker | [Name] |
| Role | [Role] |
| Start date | [Start date] |
| Inducted by | [Name and position] |
| Jurisdiction | New South Wales |
Laid out against s 19(3)(f) of the Work Health and Safety Act 2011 (NSW) (information, training, instruction and supervision) and s 39 of the Work Health and Safety Regulation 2025 (NSW): information and training must suit the work, its risks and the controls, and be readily understandable. This is a draft prepared from the details entered. It does not by itself show that your obligations are met: check it against your workplace, consult the people who will use it, and update it when things change.
1. Who to ask
- [Supervisor, first aiders, health and safety representative and WHS contact, with phone numbers]
2. Your duties as a worker
- Take reasonable care for your own health and safety.
- Take reasonable care that what you do, or don’t do, doesn’t harm anyone else.
- Follow reasonable health and safety instructions, and co-operate with our safety policies and procedures.
- Report hazards, near misses and incidents straight away.
Source: s 28 of the Work Health and Safety Act 2011 (NSW).
3. Our duties to you
[Business name] must, so far as is reasonably practicable, keep you safe at work: safe work, plant and systems, the information, training, instruction and supervision you need, adequate facilities, and consultation on health and safety matters that affect you.
4. Stopping unsafe work
You may stop, or refuse to do, work if you reasonably believe it would expose you to a serious risk from an immediate or imminent hazard (s 84 of the Work Health and Safety Act 2011 (NSW)). Tell your supervisor as soon as you can.
5. Hazards at this site and how they are controlled
- [Main hazards and the controls in place]
6. Reporting hazards and incidents
Report every hazard, near miss, injury and incident to your supervisor as soon as you can, however minor. You won’t be penalised for reporting in good faith.
7. Emergencies
[Alarm, exits, assembly point and wardens]
8. First aid
[First aiders, kit locations and how to get help]
9. Personal protective equipment
- PPE needed for each task and where to get it
- How to check, wear and store it
- Report damaged or poorly fitting PPE
10. Manual tasks
- Tasks that involve heavy, awkward or repetitive handling
- Lifting aids available and how to use them
- Ask for help rather than lift alone
- Report pain or strain early
11. Acknowledgement
I have been taken through this induction, I understand it, and I have had the chance to ask questions.
Sign-off
| Worker | Name ____________ Signature ____________ Date ________ |
|---|---|
| Inducted by | Name ____________ Signature ____________ Date ________ |
Draft prepared with a free tool. Tailor it before use. General information, not legal advice.