Short Duration Worker HSE Orientation Checklist

Form
HSE Orientation and Training Standard HSE-03-03
Company*
Name*
Orientation Date*

YearMonthDay
Date
Project*
Part One: The General HSE Orientation

Have the following been reviewed with the short duration worker:
1. Working safely is a condition of access, and of the disciplinary procedures associated with failure to adhere to this or other project site requirements?*

YesNoN/ACL
2. Legislative jurisdictional HSE requirements?*

YesNoN/ACL
3. An overview of PCL’s policies, practices and procedures?*

YesNoN/ACL
4. The Project Site Plot Plan?*

YesNoN/ACL
5. Regular hours of work, lunch breaks, and coffee breaks?*

YesNoN/ACL
6. The Pre-Job Safety Instruction (PSI) program and the following steps been explained and reviewed?*

YESRecognizing potential hazards?Controlling potential hazards?Eliminating potential hazards?Minimizing exposure to potential hazards?
7. The proper selection, care and use of the following PPE?*

YESHard HatsMonogogglesFace ShieldsSafety GlassesGlovesHearing ProtectionDust MasksSafety FootwearOther
8. HSE signs and compliance?*

YesNoN/ACL
9. Housekeeping requirements?*

YesNoN/ACL
10. Have the following site specific job hazards been reviewed? They are subject to but not limited to:*

YESDemolitionWater Service LinesGas LinesCongested Work AreasHeavy LiftsRestricted Work AreasPersonal RadiosHarmful GasesOther
11. Scaffold requirements?*

YesNoN/ACL
12. Ladder requirements?*

YesNoN/ACL
13. Guardrail requirements?*

YesNoN/ACL
14. Project fall protection plan requirements?*

YesNoN/ACL
15. Intoxicating beverages and drugs prohibited on the worksite?*

YesNoN/ACL
16. Have the following items been reviewed?

YESWorker’s Right to Refuse WorkWorkplace Violence/Harassment Policies
17. The emergency response/evacuation procedures?*

YesNoN/ACL
18. The incident reporting procedures?*

YesNoN/ACL
Short Duration Worker's Name*
Short Duration Worker's Signature*

Clear
STOP. Please hand the phone/table to the Nordic PCL employee facilitating this orientation. Do not sign below if you are not a Nordic PCL Project Team member.
Facilitator's Name*
Facilitator's Signature*

Clear
Should be Empty:

Form

STOP. Please hand the phone/table to the Nordic PCL employee facilitating this orientation. Do not sign below if you are not a Nordic PCL Project Team member.