SCMV Confined Space

Visitor Orientation Form
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
SCMV Representative

First NameLast Name
Visitor's Name

First NameLast Name
Work Site

Other
NOTICE: This visit shall be to a construction Job-Site where construction related hazards and unfinished areas may exist. There may be workers on the premises with machinery and operating tools during the visit.
Site Access: Sales Person explained site access point, obstacles, conditions.
Responsibilities: Sales person explained tour and pointed out site hazards.
General Rules: No smoking, no children under 13, must stay with escort, do not lean on temporary railings, building exit points.
Personal Protective Wear: Hard Hat, Hi-vis Vest, Covered Toe Footwear
SCMV Representative
Visitor's Signature
Should be Empty: