HSE Orientation and Training Standard HSE-03-03
Short Duration Worker HSE Orientation Checklist
Company
*
First Name
*
Last Name
*
Orientation Date
*
/
Year
/
Month
Day
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?
*
Yes
No
N/A
CL
2. Legislative jurisdictional HSE requirements?
*
Yes
No
N/A
CL
3. An overview of PCL’s policies, practices and procedures?
*
Yes
No
N/A
CL
4. The Project Site Plot Plan?
*
Yes
No
N/A
CL
5. Regular hours of work, lunch breaks, and coffee breaks?
*
Yes
No
N/A
CL
6. The Pre-Job Safety Instruction (PSI) program and the following steps been explained and reviewed?
*
YES
Recognizing potential hazards?
Controlling potential hazards?
Eliminating potential hazards?
Minimizing exposure to potential hazards?
7. The proper selection, care and use of the following PPE?
*
YES
Hard Hats
Monogoggles
Face Shields
Safety Glasses
Gloves
Hearing Protection
Dust Masks
Safety Footwear
Other
8. HSE signs and compliance?
*
Yes
No
N/A
CL
9. Housekeeping requirements?
*
Yes
No
N/A
CL
10. Have the following site specific job hazards been reviewed? They are subject to but not limited to:
*
YES
Demolition
Water Service Lines
Gas Lines
Congested Work Areas
Heavy Lifts
Restricted Work Areas
Personal Radios
Harmful Gases
Other
11. Scaffold requirements?
*
Yes
No
N/A
CL
12. Ladder requirements?
*
Yes
No
N/A
CL
13. Guardrail requirements?
*
Yes
No
N/A
CL
14. Project fall protection plan requirements?
*
Yes
No
N/A
CL
15. Intoxicating beverages and drugs prohibited on the worksite?
*
Yes
No
N/A
CL
16. Have the following items been reviewed?
YES
Worker’s Right to Refuse Work
Workplace Violence/Harassment Policies
17. The emergency response/evacuation procedures?
*
Yes
No
N/A
CL
18. The incident reporting procedures?
*
Yes
No
N/A
CL
Short Duration Worker's Name
*
Short Duration Worker's Signature
*
STOP. Please hand the phone/table to the Nordic PCL employee facilitating this orientation.
Facilitator's Name
*
Facilitator's Signature
*
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