Visitor Site Orientation

VISITOR SITE ORIENTATION CHECKLIST

TORONTO DISTRICT
Project Name*
Project Number
Orientation Date*

MonthDayYear
Date
Company Name*
Company Name*
Company Name*
Company Name*
Company Name*
Company Name*
Company Name*
Company Name*
Company Name*
CN_PDF
Visitor’s Name*
Visitor's Signature*
Signee Email
This email address will be used to send a copy of this completed document (Optional)
NOTE: ALL VISITORS MUST SIGN IN AND OUT AT THE PROJECT OFFICE EACH DAY.
PART 1: REQUIREMENTS FOR ENTRY
YESNON/A
Ramtech WES3 Systems
Invalid Answer
YESNON/A
Invalid Answer
YESNON/A
Invalid Answer
YESNON/A
Invalid Answer
YESNON/A
Safety GlassesGlovesHard HatsSafety Footwear
Safety GlassesGlovesHard HatsSafety FootwearReflective Vests
Hearing ProtectionDust MaskRespiratory EquipmentFace ShieldsMono-GogglesFall ProtectionReflective VestsOther
PART 2: ORIENTATION ACKNOWLEDGMENT
This form will be retained on file at the project work site location.
+
Take Photo of PSI Board/Sheet *
Pre-Job Safety Instruction (PSI)

Please complete a PSI at the task location prior to start of each task or when conditions change
Time*

Hour Minutes

AM/PM Option
Project Name*
Project #*
Task Location*
Muster/Meeting Point*
Review these items with the crew at the site of the task and check the boxes that apply to the work.

"HIGH RISK" activites need a HSE Operating Procedure or a JHA (Supervisor to Identify).
spill potential/containmentHAZMAT/TDG Storageweather conditionsMSDS reviewed for hazardous materialsventilation requiredheat stress / cold exposurelighting levels too lowhousekeeping
Working in a tight areaParts of body in line of fireworking above your headpinch points identifiedrepetitive motion
barricades, flagging, and signs in placehole coverings in placeprotect from falling itemspowered platformsother workers overhead/belowfall arrest systemsladders
welding/grindingburn/heat sourcescompressed gassesworking on / near energized equipmentelectrical cords / tools-conditionequipment / tools inspectedcritical lift meeting requiredenergy isolationairborne particlesopen hole(s) / leading edge(s)mobile equipment / vehicleriggingexcavation / underground work hazardsconfined space
scaffold (Inspected and tagged)slip/trip potential identifiedrequired permits in placeexcavationswalkways / roadwaysOther
clear Instructions providedtrained to use tool and perform taskdistractions In work areaworking alone (communication)Lift too heavy / awkward positionexternal noise levelsphysical limitationsfirst aid requirements
goggles / Fectogoggles / Spogglesface shieldgloves (kevlar or leather)coverall (fire retardant)hearing protectionrespiratorharness / lanyardreflective vestfootwear (condition / application)

PLEASE SELECT THE NAME OF PCL FACILITATOR AND RECEIVE 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:*
TRILLIUM
Facilitator's Name:*
Facilitator's Name:*
Facilitator's Name:*
FN_PDF
Facilitator's Signature:*
YesNo
Escort’s Name:*
Escort's Signature*
PCL Reference Number
Facilitator Email:
Shared Mailbox Email
example@example.com
Shared Mailbox Email (2)
example@example.com
MXHERO Email
example@example.com
ALL SUBMISSIONS
example@example.com
Visitor Valet Link
Should be Empty:

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VISITOR SITE ORIENTATION CHECKLIST

PART 1: REQUIREMENTS FOR ENTRY

PART 2: ORIENTATION ACKNOWLEDGMENT

Pre-Job Safety Instruction (PSI)