THE UNIVERSITY OF WESTERN AUSTRALIA

EXTERNAL CLIENT CHECKLIST

The University requires that all External Clients comply with certain legal and safety prerequisites before being able to use University equipment and facilities.  This includes demonstration of current client Worker’s Compensation and Public Liability Insurance as well as equipment and safety induction and training.  The following Risk Management Checklist must be completed and signed by the External Client prior to commencing any work.

_____________________________________________________________________
Client Name:
Position:
Organisation:
Address:
Telephone:
Fax:
E-mail:
_____________________________________________________________________

1.	Scope of Work

2.	Type of Equipment to be used

NOTE:	No other equipment may be used in the laboratories without further training.

3.	Operational Risk Assessment

Task/operation	hazard	risk rating	control	

				

				

				

4.	Copies of the Following Documents have been Submitted (please tick)

Certificate of Currency for Workers' Compensation specific to the activity being carried out.		
Certificate of Currency for Public Liability Insurance (minimum $20 million) specific to the activity being carried out.		

5.	Indicate that the Following Items have been Carried Out (please tick)

Received a copy of 'External Client Safety & Health Procedures'		
Equipment specific training (see Item 2)		
Safety Induction		

6.	Indicate the Following Items are Understood (please tick)

Fire and Emergency Procedures		
Emergency and Injury Procedures		
Accident Reporting		
Emergency Procedures		
Safety Breaches		
Personal Protective Equipment		
Arrival and Departure		
Out of Hours Work		
Smoking Policy		
Sexual Harassment		

 I,	………………………………………….			…………………………..
	(External Client's  name)					(Date)

	of……………………………………………………………………………………
	(Organisation)

declare that I have received and fully understood the above indicated information and training and am aware of and shall abide by the policies and procedures and legal and safety policies of the School of Mechanical Engineering and the University of Western Australia, along with the instructions of its Authorised Officers at all times whilst working or visiting the University.

	………………………………			………………………………
	(External Client's signature)			(Responsible Officer's signature)

This document remains valid until the expiry date of the External Client's Public Liability Insurance.