Visitor Site Orientation Checklist

Company*
Date*

MonthDayYear
Date
Project Number*
Project Name
Visitor's Name:*
Part 1: Requirements for Entry
1. Has a review of the Emergency Response/Project Site Plot Plan been completed?*

YesNoN/A
2. Has the 6 foot fall protection requirement been explained to the visitor?*

YesNoN/A
3. Has the Pre-Job Safety Instruction (PSI) program been explained and reviewed with the visitor?*

YesNoN/A
4. Is the visitor aware that he/she is to be accompanied by the escort identified below at all times?*

YesNoN/A
5.*

Safety GlassesGlovesHearing ProtectionSafety FootwearDust MaskRespiratory EquipmentHard HatsFace ShieldsMono-GogglesFall ProtectionVestsOther
Part 2: Orientation Acknowledgment
Visitor Signature*
STOP: Please hand phone/tablet to a PCL team member to complete below:
Escort's Name*
Escort's Signature*
Facilitator's Name*
Facilitator's Signature*
Should be Empty:

STOP: Please hand phone/tablet to a PCL team member to complete below: