BSBWHS401 – Implement and Monitor WHS Policies,

Procedures and Programs to meet Legislative Requirements

Appendix 1 – Toolbox Talk form

TOOLBOX TALK FORM

DATE:28/7/200019 MEETING FACILITATOR:

PROJECT NAME MEETING LOCATION:

NAME IN FULL SIGNATURE

1.

2.

3.

4.

DISCUSSION TOPICS

Possible discussions areas 1. Determine if all corrective measures have been implemented.

could include: 2. Report results of latest site safety inspection.

3. Review recent injury or accident reports. 4. Discuss current issues.

ITEMS
5. Plan future operations with safety in mind.
DISCUSSED

ANY SAFETY

ISSUES THAT
 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements

NEED

DISCUSSING

<Write discussion points here and names of any employees asking questions>

EMPLOYEE

IMPROVEMENT

SUGGESTIONS

Approved by Safety Director (your trainer): Date:

Appendix 2: Relevant legislation and organisational policies and procedures

WORK HEALTH AND SAFETY POLICY

LEGISLATIVE RESPONSIBILITIES

OBLIGATIONS

<relate to Work Health and POLICY APPLICATION

Safety Act 2012, the Work

MANAGEMENT EMPLOYEES <how is this policy being
Health and Safety Regulations
implemented?>
<what should be provided and <what each employee has an
2012, SafeWork Australia,
maintain> obligation to do>
Codes of Practice and

Australian Standards in

relation to a particular hazard>

 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements
. Review incident and employee safety
injury reports as well factor with light
as workers’ submit capacity floor cord
safety inspection covers. Our easy to
forms to relevant install, low-profile
persons (your health cord covers
and safety officer or significantly reduce
assessor) the risk of
compensation claims employees
for past instances. tripping,

• Fill in and Employees must be

submit and trained to report
incident report for any hazards to their
any incident supervisor.
involving an actual Employees should
accident or near – have a good
accident which has understanding of
involved a member risks and how they
of staff or visitor to can prevent them.
the organisation

Sketch a layout of
the work area and
mark on it where
 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements
slip and trip
incidents or risks
have been reported

Policy authorised by: Date:

Appendix 3 – Communication Plan

WHS Communications Plan

Stakeholde Communicatio Who is

Communication Method What and when
r n Need responsible?
Where the most HR or
likely management
consequence is to session.
high

Where reliable
quantitative
data is available
or can be
generated

Where the level

of definition
required by
decision
makers is high.

particularly
 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements
through continual
monitoring as well
as periodic review.

Appendix 4 – Toolbox Report

Toolbox Report

ACTIVITY NAME SAFETY OFFICER: DATE:

DETERMINE THE OBJECTIVES

NEED

COMPLIANCE

RISKS

CODE OF

AREAS OF PRACTICES

DISCUSSIONS

SAFETY

STANDARDS

IDENTIFICATION OF Carried out thoroughly, the risk identification step reveals

GAPS RISKS what, where, when, why and how something could happen
or occur and the range of possible effects on objectives

CODE OF

PRACTICES
 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements
SAFETY

STANDARDS

RECOMMENDATION

APPLICATION OF MANAGEMENT

POLICIES AND RESPONSIBILITIES

PROCEDURES

EMPLOYEE

RESPONSIBILITIES

MONITOR AND

REVIEW

Safety Officer Signature: Date:

Appendix 5 – Training plan

Go through and fill out the training plan. The information required to fill out this
training plan is the steps you took when planning your training session in task B.

WHS Training Plan

 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements
Topic:

What performance issue does this training session need to address?

Key point Bullet points Resources Costs Understanding

(what will I say) (handouts/physical (how will you check for

(training staff costs, training
demonstration/slides) understanding –
area and facility costs,
questions/observation/discu
learning material costs,
ssion)
reduced production capacity

while employees are

training, equipment costs,

etc. )

Appendix 6 – Safe Performance of procedures

SAFE PERFORMANCE OF PROCEDURES

ACTIVITY NAME: SAFETY OFFICER: DATE:

Safety controls
Job Step
Step Potential hazards Person who will
<what are you going to do to
<break the job down into
Number <what can harm you> make the job as safe as ensure this happens
steps>
possible>
 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements

Are there any inadequacies in existing risk controls according to hierarchy of control and WHS legislative requirements?

Reviewed & Approved by: Signature: Date:

Appendix 7 – Incident report

INCIDENT REPORT

Note: All sections of this form are to be completed. All incidents shall be advised within 12 hours of the incident to ensure

appropriate action is initiated.

Personal details

Family name: First name:

Contact Phone No: (w) (h - if injured)

Occupation: Gender:  M  F
 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements
Staff employment status:

Full-time  Part-time  Casual

 Contractor  Visitor

Division/Department:

Incident details

Date of incident: Time of incident: AM / PM

Location where incident occurred:

Briefly describe what happened:

This incident resulted in:

 Injury  No injury  Near miss

 Property damage  Hazard identified

The incident was reported to (Supervisor):

Name of Supervisor:____________________________________________________________________ Date: _________

Injury/damage details

If an injury was sustained, what part of the body was affected or if damage to property occurred what was damaged?

Medical treatment

If MEDICAL EXPENSES or LOST TIME is incurred, a ‘Workers Compensation Claim form’ must be completed and

forwarded to WHSW & IM Services ‘as soon as possible’.

 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements
Do you intend to seek medical treatment?  Yes  No

Do you intend to lodge a claim for workers compensation?  Yes No

Has any time been lost from work?

Yes  No
(More than 1 complete shift)

If so, have you returned to work?  Yes  No

 Yes No
Have/will medical expenses been incurred?
 Uncertain at this time

Were there witnesses? Contact phone number:

If so, name of witness(es):

Employee signature: Date:

Appendix 8 – Scheduling action meeting

SCHEDULED ACTION MEETING

Incident Name: Date:

Safety Officer: Time:

Team Members: Location:

Administrative/ General Information and Issues

Information and Issues Discussion/ decision/ task Who? By when?

Please describe the events

and contributing factors that

led to the incident:

 BSBWHS401 – Implement and Monitor WHS Policies,
Procedures and Programs to meet Legislative Requirements

Problem-solving Action Plan

Precise Problem Statement Solution Actions Who? By when Updates

Suggestions to avoid

recurrence of this

incident/accident: