worksafe act site inspection

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Page 1 of 4 Reference Code: NJ78T7 Workplace Visit report - submission confirmation Your submission has been successful. Please keep a copy of this receipt for your records. 14 Oct 2016 2:24:16 PM Date and time 99118220161014137804 Form submission ID NJ78T7 Reference number To save a copy of the completed form and receipt, from the File menu select "Save a copy". To print a copy use the Print icon. Access Canberra GPO Box 158 Canberra City ACT 2601 Telephone: (02) 6207 3000 Initial information P05757 Inspector ID * WPV-P05757-QMMWZG Inspection number CRM161014-001615 Event number Alan Chipperfield Lead inspector * N/A Accompanying inspector/other * 14 Oct 2016 Date * 9:05 Time commenced * Type of WPV * Proactive Reactive N/A Purpose of WPV * Work Health and Safety Act 2011 Legislation * Name of individual or registered company

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Page 1: WorkSafe ACT Site Inspection

Page 1 of 4

Reference Code: NJ78T7

Workplace Visit report - submission confirmation

Your submission has been successful. Please keep a copy of this receipt for your records.

14 Oct 2016 2:24:16 PM

Date and time

99118220161014137804

Form submission ID

NJ78T7

Reference number

To save a copy of the completed form and receipt, from the File menu select "Save a copy". To print a copy use the Print icon.

Access Canberra GPO Box 158 Canberra City ACT 2601

Telephone: (02) 6207 3000

Initial information

P05757

Inspector ID *

WPV-P05757-QMMWZG

Inspection number

CRM161014-001615

Event number

Alan Chipperfield

Lead inspector *

N/A

Accompanying inspector/other *

14 Oct 2016

Date *

9:05

Time commenced *

Type of WPV *

Proactive Reactive

N/A

Purpose of WPV *

Work Health and Safety Act 2011

Legislation *

Name of individual or registered company

Page 2: WorkSafe ACT Site Inspection

Page 2 of 4

ABN ACN

NOKIA

Business or trading name (if different)

Registered company address

Level 5, 60 Union Street

Address line 1 *

Address line 2

Pyrmont

Suburb *

NSW

State *

2009

Postcode

Josh Maxwell

Contact name *

0488 001 999

Contact number *

[email protected]

Email address

Workers compensation

Is a compulsory Workers Compensation Policy maintained? *

Yes No Not applicable

Details of inspection

Site/Workplace address

490 Northbourne Ave

Address line 1 *

Address line 2

DICKSON

Suburb *

ACT

State

2602

Postcode *

Page 3: WorkSafe ACT Site Inspection

Page 3 of 4

Notification of entry to (as required by s164) *

PCBU Manager

Supervisor HSR

Other N/A

Whilst undertaking an installation of antennae at the above address a review of safety systems in place was undertaken with Field Supervisor Richard Hofmann. Items of particular interest included the following; * Plant Risk Assessments * Toolbox talks * Safe Work Method Statements and associated Risk Assessments being site specific Whilst on site it was noted an active spotter in place to monitor exclusion zone and adjust the exclusion zone as works required repositioning.

Inspector notes *

Further action

Further action required? *

Yes No

Finalisation details

WPV for asbestos related issue *

Yes No

Construction

Industry group *

9:35

Time finished *

The email address below has been derived from the name you entered. Please ensure the email address is correct.

[email protected]

Lead inspector email address *

How many other email addresses would you like to send this to? *1

[email protected]

Email 1 *

Privacy notice

Page 4: WorkSafe ACT Site Inspection

Page 4 of 4

The information collected for the purpose of the Work Health and Safety Act 2011 and is in accordance with the Information Privacy Act 2014. WorkSafe ACT prevents any unreasonable intrusion into person’s privacy in accordance with the Privacy Act 1988 (C’Wlth) and Information Privacy Act 2014. WorkSafe ACT provides identifiable information which can be disclosed to other law enforcement agencies and authorised organisations that have legal authority to request information under prescribed circumstances.