OHS Initial Assessment

Please fill in the form below in order to receive an OHS Initial Assessment from Ebix Trades Monitor.

Name of Organisation

ABN

ConID

Contact

Phone Number

Address

I do not intend to go through the assessment (No fees applies) I wish to use Ebix Trades Monitor to carry out my assessment and assist me to comply

Your trades profession/trade is

Business Structure

How many people do you employ?

Which (if any) of the following do you undertake?

Structural demolition work Scaffolding or other temporary formwork Excavations and tunnelling Working with hazardous/dangerous substances, e.g. liquids Abrasive blasting Processes involving lead work, e.g. paint removal Removal or working with asbestos Building assessments Electrical work, e.g. connect/disconnect/install Work with dangerous goods/explosives/tools, e.g. ram set gun Work at heights, e.g. over 1.8 m Welding or other hot metal work Work in confined spaces, e.g. entry through craws space – ceiling Inspection or work involving abseiling Moving platforms or cherry picker

Other, please specify

Do you use Sub-contractors on a regular basis?

Signature

I accept Ebix Trades Monitor to perform the OHS Initial Assessment