Date and Time of Submission

Name

Please provide your name

Site

Please select the site attending

Job Number (if not in list)

Please enter a valid job number

High Risk Assessment

Is there High Risk Tasks performed on Site: If NO continue to sign off and submit form

Yes No

HAVE YOU READ, UNDERSTOOD & SIGNED the SWMS* Yes No Have read but do not understand

DO NOT Start any tasks until you have read, understood & signed the SWMS* Do not start working I have read and understand

Your Signature