Contractor Information

Labour Hire Competency Assessment

This form is required to determine competency of external labour hire contractor(s) required for role(s) at Dominion Constructors¹.

Information provided in this form will be used in relevant Dominion Constructors¹ systems to set Labour Hire Contractor.

¹Relative to all Dominion Group of companies

Section 1 - Labour Hire Contractor Information

First Name *

Last Name *

Labour Hire Company *

Position *

Phone

Proposed Rate ($) *

Start Date *

Section 2 - Job Information

Job Code & Name *

Site Contact's Email *

Work Start Time (24 Hour Time) *

Work End Time (24 Hour Time) *

Suburb / Region *

AucklandChristchurchQueenstownWanaka

Direct / Indirect Labour *

DirectIndirect

Section 3 - Site Safe License

Site Safe Number *

Site Safe Expiry *

Site Safe Proof *

Browse

Please upload a copy of your Site Safe card

Visa Status *

Browse

Please upload a copy of your current Visa status

Comments

Your First Name *

Your Last Name *

Your Email *

Competency

Section 4 - Work Experience

Please enter all experience in years

Construction Industry

Dominion Experience

Concreting

Finishing

Formwork

Insitu

Precast Floors

Precast Walls

Preformed

Rail Network

Reinforcement

Set Out

Other Work Experience

Amount of years

Section 5 - Other Licenses

Working At Height

Expiry Date

EWP

Expiry Date

Ramset

Expiry Date

First Aid

Expiry Date

Confined Space

Expiry Date

Forklift

Expiry Date

Hilti

Expiry Date

Other License Name

Other License Number

Other License Expiry Date

Section 6 - Skills / SoP

TRAINEE - learning and not yet competent, usually requires supervision
COMPETENT - Proficient in the safe use of the equipment and can work unsupervised
SUPERVISOR - Proficient in the safe use of the equipment, can work unsupervised, can supervise and train others in its use

Competent in the use of:

4.5" Grinder Skill Level

4.5" Grinder Last SoP Date

7" Grinder Skill Level

7" Grinder Last SoP Date

9" Grinder Skill Level

9" Grinder Last SoP Date

Skill Saw Skill Level

Skill Saw Last SoP Date

Drop Saw Skill Level

Drop Saw Last SoP Date

Jig Saw Skill Level

Jig Saw Last SoP Date

Electric Drill Skill Level

Electric Drill Last SoP Date

Dyna Drill Skill Level

Dyna Drill Last SoP Date

Hammer Drill Skill Level

Hammer Drill Last SoP Date

Nail Gun Skill Level

Nail Gun Last SoP Date

Planer Skill Level

Planer Skill Last SoP Date

Impact Wrench Skill Level

Impact Wrench Last SoP Date

Pencil Vibrator Skill Level

Pencil Vibrator Last SoP Date

Cherry Picker Skill Level

Cherry Picker Last SoP Date

Scissor Lift Skill Level

Scissor Lift Last SoP Date

Mobile Scaffold Skill Level

Mobile Scaffold Last SoP Date

Skill (Other)

Skill Level (Other)

Last SoP Date (Other)

Assessed By

Assessment Date

Assessment Method

Other Assessment Method

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