Project-Specific HSE Orientation Checklist

PROJECT-SPECIFIC HSE ORIENTATION CHECKLIST

TORONTO DISTRICT
Worker Name:*

First NameLast Name
Project Name*
Project Number
Time

Hour Minutes

AM/PM Option
Company Name*
CN_PDF
Orientation Date*

MonthDayYear
Date of Orientation
PCL HSE Online Orientation Date*

MonthDayYear
Date of Online Orientation performed on PCL Learning Portal (FOR PCL OFFICE USE)
Project Supervisor*

First NameLast Name
Project Supervisor*
Signee Email
Please enter your email if you wish to receive a copy of this form.
Taking a photo of my certificateUploading my certificate
Upload your file*
Take a Photo to upload your certificate*
YESNO
Taking a photo of my certificateUploading my certificate
Take a Photo to upload your certificate*
Upload your file*
YESNO
Error. Please select another answer.
YESNO
Error. Please select another answer.
PLEASE CONFIRM THAT THE FOLLOWING HAS BEEN REVIEWED WITH YOU ALONGSIDE PCL PERSONNEL
YESNON/A
Error. Please select another answer.
YESNON/A
Error. Please select another answer.
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YES
Hard HatsSafety GlassesSafety FootwearGloves
Hard HatsSafety GlassesSafety FootwearGlovesReflective Vests
Face ShieldsGogglesHearing Protection (85dB)Dust MasksPersonal Fall ArrestRespiratory EquipmentOther
Reflective VestsHard HatsSafety GlassesSafety FootwearGlovesFace ShieldsGogglesHearing Protection (85dB)Dust MasksPersonal Fall ArrestRespiratory EquipmentOther
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
WES3 Emergency Systems
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
YESNON/A
Error. Please select another answer
21.b Please state requirements and considerations below.
21.b Please state requirements and considerations below.
Any Additional Relevant Training (i.e. Hoisting and Rigging, Mobile Crane Operator, Vertical Drilling Rig Operator, Confined Space)
Worker's Signature*
Please Select the Name of PCL Facilitator from the dropdown List below and Receive Said Facilitator's Signature
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Signature:*
PCL Reference Number
Facilitator's Email
example@example.com
Secondary Email
example@example.com
Shared Mailbox Email
example@example.com
Shared Mailbox Email (2)
example@example.com
MXHERO Email
example@example.com
ALL SUBMISSIONS
example@example.com
Should be Empty:

PROJECT-SPECIFIC HSE ORIENTATION CHECKLIST