Short Duration Worker HSE Orientation Checklist
PCL HSE Manual - HSE Orientation and Training - Standard HSE-03-03
Company:
Visitors Name:
Orientation Date:
Project Name: Mystic Next Casino Renovation
Project Number: 5100844
=========================================
Part One: The General HSE Orientation
Have the following been reviewed with the short duration worker:
1.) Working safely in a condition of access, and of the disciplinary procedures associated with failure to adhere 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
Choose all that apply:
Recognizing potential hazards?
Controlling potential hazards?
Eliminating potential hazards?
Minimizing exposure to potential hazards?
7.) The proper selection, care, and use of the following PPE?
Yes
No
N/A
CL
Choose all that apply:
Hard Hats
Monogoggles
Face Shields
Safety Glasses
Gloves
Hearing Protection
Dust Masks
Safety
Other
8.) HSE sign and compliance?
Yes
No
N/A
CL
9.) Housekeeping requirements?
Yes
No
N/A
CL
10.) Have the following site specific job hazards been reviewed? They are subject to but not limited to:
Yes
No
N/A
CL
Choose all that apply:
Demolition
Water Service Lines
Gas Lines
Congested Work Areas
Heavy Lifts
Restricted Work Areas
Personal Radios
Harmful Gases
Other
If applicable:
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.) Have the following been reviewed?
Yes
No
N/A
CL
a) Worker's Right to Refuse Work
b) Workplace Violence/Harassment Policies
Part Two: Incident Management
17.) The emergency response/evacuation procedures?
Yes
No
N/A
CL
18.) The incident reporting procedures?
Yes
No
N/A
CL
This form will be retained on file at the project work site location.
Short Duration Worker's Name:
Short Duration Worker's Signature:
Facilitator's Name:
Facilitator's Signature
Legend: N/A = Not Application CL = Client
Submit
Should be Empty: