Visitor & Short Duration Worker Sign-In

Visitor & Short Duration Worker Sign-In
Project Number:
Project Name:
Date
Your Name:

First NameLast Name
Company
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Here to see:

First NameLast Name
Reason for Visit:
PLEASE READ BEFORE SIGNING IN: I, the undersigned, acknowledge the risk and dangers involved in entering onto this construction site, and agree to use all Personal Protective Equipment (PPE) required for my protection.

In addition, I agree to adhere to the requirements of PCL’s Project Specific HSE Plan and the Occupational Health & Safety Act and Regulations that apply on this construction site.

A mandatory HSE orientation is required for all individuals prior to going on to site (unless restricted to PPE‐free zone). Hard hat, safety boots and safety eyewear must be worn on all PCL construction sites. Your HSE orientation will advise of any additional PPE required (reflective vest, gloves, etc.) for this site.

Orientation Acknowledgment

This form will be retained on file at the project worksite location
Visitor Signature
Sign-In Time
Please remember to SIGN-OUT once your visit is over
Escort Name

First NameLast Name
Escort Signature
Facilitators Name

First NameLast Name
Facilitators Signature
Should be Empty:

Rows	YES	NO	N/A
Has a review of the Emergency Response/Project Site Plot Plan been completed?
Has the 6 foot fall protection requirement been explained to the visitor?
Has the Pre-Job Safety Instruction (PSI) program been explained and reviewed with the visitor?
Is the visitor aware that he/she is to be accompanied by the escort identified below at all time?
Have site requirements for the use of the following protective equipment been reviewed?

Requirement for Entry: