Print this checklist by clicking on the printer icon on the right side of the page.

Tick each item when it has been done and sign the form once complete.

Health and safety policies

Health and Safety in Our Practice, including:

• responsibilities under the Health and Safety at Work Act
• practice health and safety coordinator

Lone Workers

Vehicle Use, if required

Smokefree Workplace

Emergencies

Evacuation procedure, including:

• Fire warden/roles in evacuation
• Emergency exits
• Location of extinguishers and emergency equipment
• Assembly points

Emergency Procedures

Aggressive People, including how to summon help

Incidents or accidents

Incidents, including:

• Adverse Events
• Managing and Reporting Incidents including:
  • Location of the incident register
  • Reporting lines, roles and responsibilities
  • How incidents are investigated and findings communicated

Hazards

Hazard and Risk Management, including:

• Hazards in the practice
• How to report hazards
• Where records of hazards are kept

Safe work procedures, including:

• Infection Prevention and Control (IPC) including Waste Management
• Hazardous Substances

Protective equipment

Protective equipment, including:

• Location
• How to use
• N95 fit test (if applicable)

Sign acceptance

Induction completed by:

Role:

Signed:

Date:

I declare:

• I am aware of my health and safety responsibilities.
• I have been shown the emergency evacuation procedures and agree to follow them in an emergency.
• I am aware of my obligation to report incidents and hazards and I understand the procedure to do so.
• I agree to wear personal protective equipment where necessary.

Staff member:

Signed:

Date: