Short Duration Worker HSE Orientation Checklist
Company
*
Date
*
-
Month
-
Day
Year
Date
Name
*
Project
*
1. Working safely is a condition of access, and of the disciplinary procedures associated with failure 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
No
N/A
CL
7. The proper selection, care and use of the following PPE? Hard hats, gloves, monogoggles, hearing protection, face shields, dust masks, safety glasses, safety footwear.
*
Yes
No
N/A
CL
8. HSE signs and compliance?
*
Yes
No
N/A
CL
9. Housekeeping requirements?
*
Yes
No
N/A
CL
10. Have the following site specific hazards been reviewed? They are subject to but no limited to: Demolition, Heavy Lifts, Water Service Lines, Restricted Work Areas, Gas Lines, Personal Radios, Congested Work Areas, Harmful Gases and others.
*
Yes
No
N/A
CL
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. Worker's Right to Refuse Work and Workplace Violence/Harrassment Policies been reviewed?
*
Yes
No
N/A
CL
17. The emergency response/evacuation procedures?
*
Yes
No
N/A
CL
18. The incident reporting procedures?
*
Yes
No
N/A
CL
Worker's Name
*
Worker's Signature
*
*STOP: Give phone/tablet to a PCL representative to complete below
Facilitator's Name
*
Facilitator's Signature
*
Legend:
N/A = Not Applicable
CL = Client
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