Health and Safety Form

Address:

Phone:

Email:

hello@dunedinwea.org.nz

Emergency Checklist

All tutors are responsible for ensuring they are familiar with the emergency procedures of the venue they are teaching in. They must also outline these procedures to their class on the first session of each term.

Please take time to read the Health and Safety Guidelines provided with your contract, complete the form below and submit to admin.

Emergency Checklist

Checklist for Tutors and people using WEA building

	I Agree
I know where the emergency exits are
I know the wardens duties, evacuation procedure and assembly point
I know what to do in an earthquake
I know where the Defibrillator is
I know where the Alarm points are
I know where the nearest fire extinguisher is
I know where there is a first aid kit
I know where the nearest telephone is
I am familiar with the hazards in the building

Information for Tutor to give to participants prior to activity

	I Agree
Location of Toilets
Identification of any hazards and precautions
Evacuation procedure, location of emergency exits and assembly point
Location of Fire Extinguisher
What to do in an earthquake
Location of nearest telephone

I have read and agree that I understand the Emergency Checklist and upon ticking this box is the equivalent of a signature

First Name

Last Name

Organisation

Date