SITE SPECIFIC ORIENTATION FORM

SITE SPECIFIC ORIENTATION FORM
Company
Project Name
Project Number
Project #
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date of Online orientation completion

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Worker Name

First NameLast Name
Facilitator to use the site-specific orientation information document to ensure all items are reviewed correctly. Worker to tick off items as reviewed.

The following items were reviewed with the worker:

Rows	Yes	No	N/A
Project Management introduction and safety commitment
Site information and logistics (including emergency procedures)
Incident Reporting Procedures
PPE requirements
PSI Process
Client specific requirements
Current/ active life saving absolutes on this project
Other high-risk activities or project specific hazards
Project Specific procedures
Mandatory training requirements
Other

Worker Signature
To be completed by facilitator: Verification of online orientation completion Medical questionnaire issued Other applicable training verified

To be completed by facilitator:

Rows	Yes	No	N/A
Verification of online orientation completion
Medical questionnaire issued
Other applicable training verified

Facilitator Name
Signature
Note: Worker's supervisor to review crew specific procedures and show workers around site once the above has been completed.
Should be Empty: