Site Specific Orientation

COMPANY NAME*
WORKERS NAME*
PROJECT SUPERVISOR*
Project:*
Orientation Date*

DayMonthYear
Date
YesNo
If Yes, Location of Orientation:
YesNo
If you answered "No" to the question above your tasks must exclude working above 6 feet, working on any form of Elevating Work Platform, working in proximity to edges or anywhere a fall hazard exists.
SITE SPECIFIC INFORMATION
YesNoN/ACL
Harmful GasesRestricted Work AreasTraffic/DeliveriesToolsOverhead ActivityDemolitionStored EnergyAerial LiftsCongested Work AreasUnderground/Above Ground UtilitiesElectrical SafetyHand and Finger SafetyOther

Rows	Yes	No	N/A	CL
2. Review of the project site plot plan including location of muster areas, first aid stations,spill kits, etc.
3. Medical facilities and services on and off the job
Responsibility to provide first aid coverage
4.On-site fire prevention, emergency notification, and emergency response plan
5. Project fall protection plan requirements
6. Emergency response for spills
7. Mandatory attendance at HSE Field Meetings
8. Regular hours of work, lunch breaks, and coffee breaks
9.a) Any other items?

9.b) Describe which other items (i.e. Workers' Right of Refusal, Codes of Practice, Special Client Requests, Special Pre-job, Worker Access to Exposure Records and Medical Records, Mold Considerations, Workplace Violence Policy)
YesNoN/ACL
PRE-JOB SAFETY INSTRUCTION (PSI) PROGRAM & JOB HAZARD ANALYSIS (JHA) PROGRAM

Rows	Yes	No	N/A	CL
11. Pre-Job Safety Instruction (PSI) and the following steps:
11.a) Recognizing potential hazards?
11.b) Controlling potential hazards?
11.c) Minimizing exposure to potential hazards?
12. The worker should request a PSI and a JHA, if applicable, from his foreman upon leaving this orientation and joining his/her crew
13.Additional PPE Requirements

PCL/ED Site Specific Orientation