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Temporary Assignment Assessment

* Job Title

Name of Temporary Worker

* Client / Host Employer

* Physical location of work

* Place of work type

If other, please specify

* Workplace / Site Controller if not the Client (Principal Contractor, Third Party Facility)

* Placement Commencement

* Hours of work

* Summary of tasks / jobs

* Supervisor Name

* Supervisor Contact

* Supervision Provided

* Qualifications (licenses etc) that the worker must possess:

* Experience the worker should possess:

Other selection criteria (eg medical)

* Training provided

* Specify PPE Requirements if required

* Hazards associated with tasks / environment

How are these hazards managed?

* Job Risk Level

Low

High

Managed

* Placement management strategy

Completed by:

* First Name

* Last Name

* Email

Mobile

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* Date completed

Director authorisation (High risk only)

Date authorised