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Reference Code: NJ78T7
Workplace Visit report - submission confirmation
Your submission has been successful. Please keep a copy of this receipt for your records.
14 Oct 2016 2:24:16 PM
Date and time
99118220161014137804
Form submission ID
NJ78T7
Reference number
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Access Canberra GPO Box 158
Canberra City ACT 2601
Telephone: (02) 6207 3000
Initial information
P05757
Inspector ID *
WPV-P05757-QMMWZG
Inspection number
CRM161014-001615
Event number
Alan Chipperfield
Lead inspector *
N/A
Accompanying inspector/other *
14 Oct 2016
Date *
9:05
Time commenced *
Type of WPV *
Proactive Reactive
N/A
Purpose of WPV *
Work Health and Safety Act 2011
Legislation *
Name of individual or registered company

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ABN ACN
NOKIA
Business or trading name (if different)
Registered company address
Level 5, 60 Union Street
Address line 1 *
Address line 2
Pyrmont
Suburb *
NSW
State *
2009
Postcode
Josh Maxwell
Contact name *
0488 001 999
Contact number *
josh.maxwell.ext@nokia.com
Email address
Workers compensation
Is a compulsory Workers Compensation Policy maintained? *
Yes No Not applicable
Details of inspection
Site/Workplace address
490 Northbourne Ave
Address line 1 *
Address line 2
DICKSON
Suburb *
ACT
State
2602
Postcode *

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Notification of entry to (as required by s164) *
PCBU Manager
Supervisor HSR
Other N/A
Whilst undertaking an installation of antennae at the above address a review of safety systems in place was undertaken with Field
Supervisor Richard Hofmann. Items of particular interest included the following;
* Plant Risk Assessments
* Toolbox talks
* Safe Work Method Statements and associated Risk Assessments being site specific
Whilst on site it was noted an active spotter in place to monitor exclusion zone and adjust the exclusion zone as works required
repositioning.
Inspector notes *
Further action
Further action required? *
Yes No
Finalisation details
WPV for asbestos related issue *
Yes No
Construction
Industry group *
9:35
Time finished
*
The email address below has been derived from the name you entered. Please ensure the email address is correct.
Alan.Chipperfield@act.gov.au
Lead inspector email address *
How many other email addresses would you like to send this to? *
1
josh.maxwell.ext@nokia.com
Email 1 *
Privacy notice

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The information collected for the purpose of the Work Health and Safety Act 2011 and is in accordance with the Information Privacy Act
2014. WorkSafe ACT prevents any unreasonable intrusion into person’s privacy in accordance with the Privacy Act 1988 (C’Wlth) and
Information Privacy Act 2014. WorkSafe ACT provides identifiable information which can be disclosed to other law enforcement agencies
and authorised organisations that have legal authority to request information under prescribed circumstances.