Coal Board Medical, Chest X-Ray Or Coal Board Medical (Sub-Contractor), Chest X-Ray (Sub-Contractor) | - Must include QLD Section 4 certificate
- Applicant name on medical to match the name registered in the system
- Applicant date of birth (DOB) must be displayed on medical and match the DOB on system
- Must include accurate Job role
- Company name must match Contractor portal name UNLESS the Coal Board Medical (Sub-Contractor) competency has been selected and uploaded against.
- Name of mine must be either Various or Fitzroy entities eg. Carborough Downs, Ironbark No.1, Broadlea, Exploration (if unsure refer to HSR)
- Must include Respiratory function & chest Xray summary
- Section 4.3(e) – Medical is to be cleared when the ticked box is:
- “Is fit to undertake any position” and no restrictions are written below. Or,
- “Is fit to undertake the proposed / current position” and no restrictions are written below. Or,
- “Is fit to undertake the proposed/current position subject to the following restriction(s) (if necessary, outline a management program)” AND
Restrictions are written below AND A Medical Management Plan (MMP) is attached (scanned) to the section 4 as one document which is signed by the employee and their supervisor. (does not need to be signed by a Fitzroy representative) - See notes for more detail on what restrictions Pegasus are authorised to accept.
- See notes for more detail on what restrictions Pegasus are authorised to accept.
- If “Is not fit to undertake the proposed/current position because of the following restriction(s)” is ticked, refer to HST Dept who will assess the Medical.
- Must be stamped and signed by the medical practitioner (AMA)
| - Issue Date: Date of the AMA sign off (bottom of last page Section 4.5)
- Expiry Date: Whichever is earliest –
- As listed in section 4.3(c)
or - As listed in section 4.3(a)
*Ensure this date is 5 years after date listed in section 4.1(h) - All restrictions must have an MMP attached to the Section 4.
A generic MMP will be available from the contractor portal or can be requested from the HST Dept
Common restrictions which Pegasus personnel are authorised to accept: - Hearing conservation/ protection related restrictions
- Corrective lenses related restrictions
- Medical condition related restrictions IF the restriction is generalised and non-specific. E.g. “Adhere to Medical Management Plan by own GP/Specialist”
REMINDER – All these restrictions MUST have an accompanying MMP which has been scanned into the same document as the Section 4. All other restrictions, including an MMP, must be forwarded to the HST Dept for authorisation.
Please see forms below to download and complete if required: Medical Declaration Medical Management Plan Template (Contractors) |
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| Medical.Certificate.Queensland Coal Board | · Applicant name on medical to match the name registered in the system · Applicant date of birth (DOB) must be displayed on medical and match the DOB in onsite · Must be stamped and signed by the medical practitioner · Must be a QLD Section 4 certificate · Must include accurate Job role (This does not need to match Onsite role) · If the fitness for duty section is ticked - “Is fit to undertake the proposed/current position subject to the following restriction(s)” OR “Is not fit to undertake the proposed/current position because of the following restriction(s)” the Medical will be required to be sent to site for review · Must include Respiratory function & chest Xray summary · Company name must match Contractor portal name · Name of mine must be either Various or Fitzroy entities eg. Carborough Downs, Ironbark No.1, Broadlea, Exploration (if unsure refer to HSR) | · Issue Date: date of examination by the EMO (EMO date not the NMA sign off date) · Expiry Date: five (5) years from the date of examination UNLESS there is a review date which then becomes the end date | Induction Medical Declaration form | - CDCMC-FRM-0021-6 Medical Declaration form Employee section & physical assessment section must be completed in full excluding HST Superintendent Name & signature
- Employee name on form must be the same as name registered in the system
- DOB on form must match the DOB in onsite
- Form must be signed by employee and supervisor
- Where a medication is declared, form must be referred to HSR team
- Where employee ticks yes for any condition in physical assessment section or lists other- refer form to HSR team
If no medications or conditions, form can be cleared by Pegasus team. | - Must be signed by employee
- Must be signed by workers supervisor
If medication declared, must have prescription attached unless box ticked “No Prescription Required” |
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