Cleanaway - Making a sustainable future possible

Cleanaway Induction Assessment & Declaration

Thank you for taking the time to listen to the Welcome to Cleanaway – induction video!
Please complete the following five questions to assess your understanding of the video information.

What is our mission? Please mark one correct answer:

o To make the future possible for our customers, shareholders, communities and our people

o To sustainability create the future for our customers, shareholders, communities and our people

o To make a sustainable future possible for our customers, shareholders, communities and our people

Which of the following are our Cleanaway Values? Please mark four correct answers:
o Stronger together

o Clarity for alignment

o We make a difference

o Home safe

o Customer for growth

o Integrity

We believe everyone deserves to go home safe, every day and we aim for Zero Harm across the company.
Which of the following are expectations of all employees and contractors, to assist with our goal of Zero Harm?
Please mark four correct answers:
o Report any hazards or identified risks and all incidents which cause or could potentially cause injury or
damage
o Carry out your work in accordance with Cleanaway’s safety policies, processes and procedures

o Stop work if there is a threat to your safety, or the safety of others

o Be accountable for our own safety, and that of others

o Continue to work if there is a deadline, regardless of whether there is a threat to health and safety

Cleanaway Induction Assessment and Declaration – Labour Hire Page 1 of 2

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 Cleanaway - Making a sustainable future possible

Is the following statement true or false?

There are six Lifesaving Rules, and they are compulsory for all employees and contractors. A proven breach of
these rules is likely to result in immediate dismissal.
o True
o False

Is the following statement true or false?

Cleanaway will not tolerate any form of discrimination, harassment, bullying or victimisation within or
outside of the working environment.
o True

o False

Congratulations!
By signing the below, you acknowledge you have completed watching and understood the Cleanaway induction
video.

Employee Name _____________________________________________________________________

Date _____________________________________________________________________
Signature _____________________________________________________________________

PLEASE BRING ALONG A COPY OF THIS ASSESSMENT AND DECLARATION ON YOUR FIRST DAY. PLEASE
PROVIDE TO YOUR CLEANAWAY REPRESENTATIVE.

Cleanaway representative to complete to acknowledge that the answers given by labour hire worker were
correct / corrected accordingly. The labour hire supplier will record the completion. Please retain a copy of this
Assessment and Declaration form.

Representative Name _____________________________________________________________________

Position Title _____________________________________________________________________
Date _____________________________________________________________________
Signature _____________________________________________________________________

The labour hire supplier will record the completion. Please retain a copy of this Assessment and Declaration
form.

Cleanaway Induction Assessment and Declaration – Labour Hire Page 2 of 2

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