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
1. Has a review of the Emergency Response/Project Site Plot Plan been completed?
Ramtech WES3 Systems
Invalid Answer
2. Has the 6-foot (2-meter) fall protection requirement been explained to the visitor?
Invalid Answer
3. Has the Pre-Job Safety Instruction (PSI) program been explained and reviewed with the visitor? Has a PSI been completed (on reverse)?
Invalid Answer
4. Is the visitor aware that he/she is to be accompanied by the escort identified below at all times?
Invalid Answer
5. Have the site requirements for the use of the following protective equipment been reviewed?
5a. Required
5a. Required
5b. Additional PPE

Other
PART 2: ORIENTATION ACKNOWLEDGMENT
This form will be retained on file at the project work site location.
PLEASE COMPLETE PSI OR CHECK BOX IF PROJECT PSI BOARD SIGNED
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).
Environmental Hazards
Ergonomics Hazards/Material Handling
Work at Hight Hazards
Activity Hazards
Access/Egress Hazards

Other
Personal Limitations / Hazards
PPE Requirements

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:
Will the form facilitator also be performing the escort?
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:

Rows	TASK STEPS	HAZARD	CONTROL
1
2
3
4
5
6
7
8
9
10
11
12

VISITOR SITE ORIENTATION CHECKLIST

PART 1: REQUIREMENTS FOR ENTRY

PART 2: ORIENTATION ACKNOWLEDGMENT

Pre-Job Safety Instruction (PSI)