External contractor - Activity - Maintenance form

NOTE - IF YOU HAVE NOT BEEN APPROVED REFUSAL OF ENTRY IS INSTANT.

Use this form to record the regular, perhaps urgent maintenance requirements within a BOORN location. Ensure that anything urgent or a supervisor needs to be advised, and act accordingly.

or a regular provider to the company like a child entertainment, or development provider.

Have you been APPROVED to be onsite? *

Yes - Continue the formNO - Entry and works are not permitted

Have you completed the relevant inductions?

Yes No Unsure

Location *

Mandurah Port Kennedy BunburyOther

Purpose *

Urgent works Planned - Regular workUnsure Other

Who has requested this *

General on the Day Staff MemberSupervisor Senior Managment Parent - Customer Not applicable Other

BOORN Member Name

Your Name *

Trade ie, Plummer, fire safety, *

Company Name *

Your contact phone *

Working with children card *

Yes No - You may require on of our staff to monitor you, a cost may apply. Unsure

Photo of WWC

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Have you had any legal investigations in last 10 years *

Yes - Talk to management asap No

NDIS screening *

Yes - Supply evidenceNo - Seek approval, you may require this to enter

NDIS Screening

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Do you have a 185 Clearance? *

Yes - SupplyNo - You must seek approval before entering

185 clearances

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Insurance certificate

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Are you required to have license - Rego for your qualification? If so provide details *

Contractor Email

Purpose and job completing today *

If Applicable (If works continuing an invoice, this must be completed, resubmit to first approval)

Before

Before Photo 1: *

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Before Photo 2: *

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Before Photo 3:

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Before Photo 4:

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Description: *

Main Maintenace points - Comments

Further Action required?

After

After Photo 1: *

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After Photo 2: *

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After Photo 3:

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After Photo 4:

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Action and task completed

Further action *

No Action - All fixed Notify senior Management.Need to seek a another professionalNothing required. Other

I agree I have addressed the situation to the best I could *

Yes No

Comments

Signature

Draw signature|Type signatureClear

Date of report

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