Visitor Site Orientation Checklist

Visitor Site Orientation Checklist
HSE Orientation and Training Standard HSE-03-04
Company*
Orientation Date*

YearMonthDay
Date
Project Number*
Project Name*
Visitor's Name*
1. Has a review of the Emergency Response/Project Site Plot Plan been completed?*

YesNoN/A
2. Has the 6 foot fall protection requirement been explained to the visitor?*

YesNoN/A
3. Has the Pre-Job Safety Instruction (PSI) program been explained and reviewed with the visitor?*

YesNoN/A
4. Is the visitor aware that he/she is to be accompanied by the escort identified below at all times?*

YesNoN/A
5. Have site requirements for the use of the following protective equipment been reviewed?*

YesNoN/A
5.1 What personal protective equipment is required?*

Safety GlassesGlovesHearing ProtectionSafety FootwearDust MaskRespiratory EquipmentHard HatsFace ShieldsMono-GogglesFall ProtectionVestsOther
Part 2: Orientation Acknowledgment

This form will be retained on file at the project worksite location
Visitor's Signature*
STOP. Please hand phone/tablet to Nordic PCL employee for completion.
Escort's Name*
Escort's Signature*
Facilitator's Name*
Facilitator's Signature*
Should be Empty:

STOP. Please hand phone/tablet to Nordic PCL employee for completion.