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Contact Information

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Name

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Phone Number

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Business Name

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Postal Address

Postal Suburb

Postal City

Physical Address

Physical Suburb

Physical City

Business Phone

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Medical and Health & Safety Courses

Please complete the following section if you require a quote for training including Medical or Health & Safety Courses.

Preferred Date/Time

Are there any specific unit standards required?

Are there any specific subjects that need to be taught/covered?

Training Address for on-site training

Number of people attending

Special Requirements (PPE Required / Onsite Induction)

What if any, are the main hazards in your organisation?

On Site Facilities (Tick if available)

Training Room Projector TV Whiteboard Parking Internet Access Sound System Tea/Coffee facilities available

Comments

Safety Services, Health & Safety Advisor or Alcohol & Drug Screening

Please complete the following section if you require a quote for Safety Services, Health & Safety Advisor or Alcohol & Drug Screening services.

Location of H & S work

Preferred Date/Time

Special Requirements

Hazards

Qualification Level Required

Comments

Medic Requirements

Please complete the following section if you require a medic at your site.

Location for medic work

Preferred Date/Time

Special Requirements (ie confined space, heights, industrial BA)

PPE requirement

Qualification Level Required

First Responder

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EMT Basic Life Support

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EMT Intermediate Life Support

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EMT Advanced Life Support

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Comments

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