Site Information If directed by your consultant, please fill in the form below with your custom site information: Web Site Site Information Trading Name * Street Address * Suburb * State * Postcode * Main Phone Number * Capricorn Number (if applicable) Capricorn number (if applicable) Number of Employees at this site * 10+ Include full-time, part-time and semi-permanent staff Person in Charge This person is ultimately responsible for the site Name * Email * Mobile Number * Accounts Contact For billing and other administration Accounts Name Accounts Email * Accounts Phone Number WHS Contact This person will receive and complete the tasks to do each month WHS Name * WHS Email * WHS Mobile Number * Is this the person who will be trained? YesNo Warehouse Facility Please fill in warehouse information if relevant Is there a warehouse facility on this site? YesNo