PCL HSE Manual - HSE Orientation and Training
Standard HSE-03-04
Visitor Site Orientation Checklist
Company:
*
Orientation Date:
*
DD/MM/YY
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?
*
Yes
No
N/A
2.) Has the 6' fall protection requirement been explained to the visitor?
*
Yes
No
N/A
3.) Has the Pre-Job Safety Instruction (PSI) program been explained and reviewed with the visitor?
*
Yes
No
N/A
4.) Is the visitor aware that he/she is to be accompanied by the escort identified below at all times?
*
Yes
No
N/A
5.) Have the site requirements for the use of the following protective equipment been reviewed?
*
Yes
No
N/A
Check all that apply:
*
Safety Glasses
Gloves
Hearing Protection
Safety Footwear
Dust Mask
Respiratory Equipment
Hard Hats
Face Shields
Mono-Goggles
Fall Protection
Vests
Other
Part 2: Orientation Acknowledgement
This form will be retained on file at the project worksite location
Visitor's Signature:
*
Escort's Name:
*
Escort's Signature:
*
Facilitator's Name:
*
Facilitator's Signature:
*
December, 2012
Rev. 04
Submit
Should be Empty: