HSWA induction form - Waiheke Island Marina

Prior to completing this form:

Please carefully review our health & safety policy, registration and insurance requirements here.

Company & personal details

Name*

First Name Last Name

Job title

Email address*

Phone no

Company name

Business & services description

Tell us about your business activities and the services you will be providing.

Upload insurance certificates

Please upload certificates of currency for Public Liability Insurance and Ship Repairers Liability Insurance (where applicable).

Insurance certificates

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 2 MB.

Contractor health & safety agreement

Under the provisions of the Health and Safety at Work Act 2015 and its Regulations, the marina facility is deemed to be a 'place of work' and as such all contractors, their employees, their sub contractors and their employees, must take all practicable steps to ensure that their actions or lack of action does not cause harm to anyone.

Declarations*

I hereby formally apply for registration as an approved contractor for the purposes of providing services as described herein

I acknowledge that I have read the Waiheke Marina site specific safety induction and fully understand my obligations and responsibilities with regard to Health and Safety and Emergency Procedures at the marina

I agree to abide by the terms and conditions as stated throughout this Health and Safety Induction

I undertake personal responsibility to maintain a safe work site and practices whilst on marina property

I agree to Waiheke Marina conducting random safety audits of my activities to ensure Health and Safety compliance whilst on this site

My business shall provide Personal Protective Equipment (PPE) and specialist training to employees where required. Employees agree to use PPE where provided

My business will maintain adequate insurance cover relevant to the work being performed throughout my tenure as an 'Approved Contractor'

I undertake to keep Waiheke Marina indemnified against any legal liability, loss, claim or proceedings for personal injury to, or death of any person, or for the loss, injury or damage to property, or for the penalties incurred as a result of any activity by myself or my employees, agents or sub-contractors.

I understand that should I be found in breach of any of these Health and Safety requirements my approved contractor status may be suspended or revoked at any time