Maintenance Scope Templates
Work Authorization Form
The Form is used by the Operations Teams for authorization of Works outside the Sections normal Operating Hours.
Contract Close Out
The Contract Close Out form is filled at the end of all maintenance works and new builds. The Contract Close Out is to be filled and endorsed by an employee of the University supervising the Work. The checklist to be filled by the Supervising employee with the contractor with regards to the scope of Works. The form is then endorsed by the Client/project Sponsor.
USP Identified Hazard Report Form A01
Safety Improvement Notice ( SIN )
USP Safety Improvement Notice Form A02
Injury & Incidents
USP Injury Hazard Incident Report Form
USP Work Accident Statement Worker & Witnesses
USP Work Accident Statement Supervisor
Notification of Workplace Injury to Ministry of Labor – OHS
The OHS F1 form is to be filled immediately following any workplace injury by OHS officers and attending medical doctors sent to Ministry of Labor – OHS
The QBE Workman compensation claim form is to be filled together with Fiji LDF C1 Form and sent to USP insurance brokers.
QBE Workman Compensation Claim Form
Fire Incident / Evacuation Forms
USP E01 Forms are to be filled by Chief Building Wardens following a building or campus evacuation due to actual fire or activated fire alarm in a building
Fire Evacuation Evacuee Register : USP OHS Form E01
USP E02 forms are to be filled by OHS staff in consultation with the USP staff member filling the USP OHS Form E01, following a building or campus evacuation due to actual fire or activated fire alarm in a building.
Fire Alarm / Evacuation Report Form : USP OHS Form E02
Workplace Inspection Forms
USP Administrative Space Inspection Form
USP Teaching Spaces Inspection Form
USP Science Laboratory Inspection Form
USP Residential Spaces Inspection Form
Safety Permit to Work Forms
The following Safety Permit to Work Forms are to be filled on daily basis by designated OHS officer and supervising officer / contractor conducting the work at site
Work at Heights Safety Permit Form
Excavation Works Safety Permit Form
USP OHS Training Application Form
USP Staff Training Attendance Register Form