Staff Availability Form

OHS 409 F1

This form is used as part of Ermha’s Emergency Preparedness Policy and Procedure and assists service planning in the event of an emergency.

Please note that if you elect to not attend work due to a CFA Fire Danger Rating being issued, you are expected to demonstrate that this is appropriate by selecting one or more of the ‘reasons’ below and detailing additional information in the space provided.

In event of an appropriate absence, personal leave will be accessed by the use of a Statutory Declaration- identifying your reason/s for non-attendance. If you do not have adequate personal leave then annual leave may be utilised.

Please refer to http://www.cfa.vic.gov.au/plan-prepare/community-information-guides/ for risk area ratings.

Employee Details
Name / Program
Home address / Private phone number
Emergency contact / Name / Phone number
Questionnaire
Would you come to work if a CFA Fire Danger Rating was issued?
If no, at what fire danger rating would you not attend work? / Code Red / Extreme / Severe
If you have elected to not attend work due to a CFA Fire Rating being issued, please indicate your reasons below:
Dependents to care for during school/childcare closure / School/childcare name
Contact number
Member of the CFA/SES / Member no.
Level of bushfire risk at home address is ‘high’ / Area name
Commute through ‘high’ risk area / Areas
In an emergency would you be prepared to work after hours?
Is there anything else you feel it is important for Ermha to be aware of?
VERSION NO. / DATE APPROVED: / SHORT DESCRIPTION OF AMENDMENT / TO BE REVIEWED:
1. / 2010 / New Form / 01/10/2013
2 / 24/10/2013 / Revised Form / 01/10/2016
3 / 06/11/2015 / Revision in line with OHS 409 / 06/11/2017
Doc No: OHS 409 F1 / Version No: 2 / Date of Issue: 06/11/2015
Author Title: MQS / Authoriser Title: DSD / Approver Title: CEO
CONTROLLED COPY / Uncontrolled Copy When Printed
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