Vendor & Delivery Driver Safety Orientation
Name
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First Name
Last Name
Company Name
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Phone Number
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Format: (000) 000-0000.
Email
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example@example.com
Nature of Your Visit
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Delivery Driver
Vendor
Visitor
Other
If Other, please briefly describe the nature of your visit
1. STOP WORK AUTHORITY: Everyone working on Pulsar Helium has the right and responsibility to stop any job.
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I agree to meet this requirement
I do not agree to this requirement
2. REPORTING: All incidents, accidents, near misses and environmental threats must be reported to your supervisor immediately.
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I agree to meet this requirement
I do not agree to this requirement
3. VEHICLE SAFETY: Obey all posted speed limit signs on lease roads and on location. 5 mph on location unless otherwise posted.
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I agree to meet this requirement
I do not agree to this requirement
4. SMOKING: Smoking is allowed only in designated smoking area (includes vapor devices).
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I agree to meet this requirement
I do not agree to this requirement
5. DRUG AND ALCOHOL: Anyone found in possession of illegal drugs or alcohol will be immediately escorted off location (excludes alcohol for company sanctioned events and locations).
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I agree to meet this requirement
I do not agree to this requirement
6. PPE: Hard hat, steel toe boots, ANSI approved safety glasses with side shields, and ear plugs (in heavy noise area) are required at all times while working on location. PPE recommended on SDS must be worn when handling chemicals.
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I agree to meet this requirement
I do not agree to this requirement
7. JEWELRY: Any bodily wearable items that present a snagging or catching hazard are not permitted in work areas where snag and catch hazards are present.
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I agree to meet this requirement
I do not agree to this requirement
8. WORKING AT HEIGHTS & FALL PROTECTION: Pulsar Helium requires fall protection be worn at elevations of four feet in general industry workplaces and six feet in the construction industry. In addition, OSHA requires that fall protection be provided when working over dangerous equipment and machinery, regardless of the fall distance.
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I agree to meet this requirement
I do not agree to this requirement
9. JOB PLANNING: All jobs shall have a plan that identifies and mitigates the hazards. If something presents a controllable hazard then the job plan must be modified to control or eliminate the hazard. Any worker that observes an at risk condition or behavior is obligated to stop the work and correct the at risk behavior or condition.
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I agree to meet this requirement
I do not agree to this requirement
10. PERMITS TO WORK: All workers are required to complete a permit anytime work involves energy isolation, hot work, trenching or excavation, or confined space entry. workers are required to adhere to their respective employers work permit program. All trenching and excavation work must be supervised by a Competent Person as defined by OSHA construction regulations.
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I agree to meet this requirement
I do not agree to this requirement
11. SAFETY DATA SHEETS: Copies of SDS sheets shall accompany all chemicals supplied to a Pulsar Helium work site or warehouse. Pulsar Helium maintains an SDS library at: https://safehe.com/
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I agree to meet this requirement
I do not agree to this requirement
12. OPERATING EQUIPMENT: Only trained and qualified personnel are authorized to operate forklifts and mobile working platforms such as man lifts and scissor lifts. Cranes are to be operated by qualified personnel only, and all cranes must have a current inspection.
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I agree to meet this requirement
I do not agree to this requirement
13. EMERGENCY: Emergency phone numbers and GPS coordinates are located at https://safehe.com/. contractors are required to establish and communicate evacuation and muster plans to their respective employees.
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I agree to meet this requirement
I do not agree to this requirement
14. SIGN IN SHEET: All contractors are required to track their respective employees working on a Pulsar Helium worksite.
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I agree to meet this requirement
I do not agree to this requirement
15. VEHICLES & EQUIPMENT SPOTTERS: All heavy vehicles and equipment being operated in tight or confined work areas must follow their respective employers vehicle operation policies, procedures, and/or best/safe work practices.
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I agree to meet this requirement
I do not agree to this requirement
If you desire additional information regarding the safety expectations of Pulsar Helium, or if you intend to engage in more then a brief hands-off visit to a Pulsar Helium location, we ask that you complete the Pulsar Helium Safety Orientation for Field Workers located at the following link: https://safehe.com/
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I understand
I do not understand
Signature of Attendee
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