1. Health and Safety Policy

Commitment to participation in safety
I am committed to the health and safety of our staff, contractors and clients. As a team member I agree to participate fully in safety meetings and I will consider the safety of me and others around me as I am planning and carrying out my duties.

Never work under the influence of drugs or alcohol
During work hours I will not use or have in my possession or be under the influence of

  • Alcohol (this includes hangovers)
  • Prescription medication not specifically prescribed to me
  • Illegal or recreational drugs such as “synthetic Cannabis”
  • Instruments for the purpose of using illegal drugs

Prescription medication
If I am using prescription medication which may impair my ability to work safely or operate machinery or tools. I agree to:

  • Remove myself from the work, machinery or tools
  • Report to my supervisor and advise him of the situation

Workplace drug testing
To ensure my safety and that of my team members I agree that the company may require me to a drug test according to the procedure below.

  • Testing may be prior to employment
  • Testing may be on any team member the company chooses without evidence or just cause or it may be following a safety or conduct related incident
  • Drug test must be done when requested and without delay
  • The staff member I will accompany the supervisor to a private or public toilet facility
  • To ensure there is no tampering with the test a member the same gender will supervise the sample collection this includes
  • Removal of loose clothing and lifting of the shirt to ensure no substitution can be made
  • The supervisor will need to observing urination into the sample cup
  • The team member being tested must keeping the sample in sight to prevent dilution or additives
  • The team member must pass the sample to the testing supervisor

Not following safety policy or false statements
In the case where the staff member does not comply with any part of this procedure or if you are found to be under the influence of alcohol illegal or unauthorised drugs or fails to give an accurate statement of police history may be disciplined in one or more of the following ways.

  • You may be asked to stand down temporarily
  • You may be asked to provide a NZ Police History from the district court
  • You may be dismissed permanently
  • There may be an opportunity for a drug test at a later date
  • You could be asked to commit to drug counselling
  • In the case where you are dismissed or stood down you will not be entitled to any compensation in lieu of work

Disciplinary Action
The company will at its discretion determine appropriate disciplinary action taking into account the following factors.

  • The nature of any substance(s) you tested positive for;
  • Your integrity throughout the process
  • Your history with the company
  • Any evidence you provide that you have entered drug and alcohol counselling

I will comply with the company Health and Safety Policy including the drug and alcohol section (Tick one)
YesNo

Please write your full name (To verify your agreement)


2. Personal Details

First Name (Required)

Last Name (Required)

Email (Required)

Phone (Required)


3. Drivers License Details

Drivers license number (Required)

Your drivers license-classes held

Your drivers license-expiry date


4. Next of kin

Name of your next of kin (In case of emergency)

 
 
 

Next of kin address

Next of kin phone


5. Criminal background check

Please provide a full history of any criminal offences you have had over the past 10 years including drink drive or disqualification offences.
No neverYes (Please see details below)

Name of the Offence, Year (Approximate), details of sentence received

Agreement to police background check

Are you happy to provide a NZ Police history of any criminal offending? (tick one)
YesNo

Please write your full name to confirm that the police history you have given is complete and accurate


Return back to the contractors agreements & forms page HERE.