AC PCL Short Duration

Part One: The General HSE OrientationHave the following been reviewed with the short duration worker:*

Rows	Yes	No	N/A	CL
1. Working safely is a condition of access, and of the disciplinary procedures associated with failure to adhere to this or other project site requirements?
2. Legislative jurisdictional HSE requirements?
3. An overview of PCL's policies, practices and procedures?
4. The Project Site Plot Plan?
5. Regular hours of work, lunch breaks, and coffee breaks?
6. The Pre-Job Safety Instruction (PSI) program and the following steps been explained and reviewed? (see next question)

6.a) PSI program the following have been explained and reviewed:*

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?*

Hard HatsMono-gogglesFace ShieldsSafety GlassesGlovesHearing ProtectionDust MasksSafety FootwearOther

Rows	Yes	No	N/A	CL
8. HSE signs and compliance?
9. Housekeeping requirements?
10. Have the following site specific job hazards been reviewed?

10.a) Job hazards are subject to but not limited to:*

DemolitionWater Service LinesGas LinesCongested Work AreasHeavy LiftsRestricted Work AreasPersonal RadiosHarmful GasesOther

If applicable:*

Rows	YES	NO	N/A	CL
11. Scaffold requirements?
12. Ladder requirements?
13. Guardrail requirements?
14. Project fall protection plan requirements?
15. Intoxicating beverages and drugs prohibited on the worksite?
16. Have the following items been reviewed? (see next question)

16.a) Been reviewed?*

Worker's Right to Refuse WorkWorkplace Violence/Harassment Policies
Part Two: Incident Management
17. The emergency response/evacuation procedures?*

YESNON/ACL
18. The incident reporting procedures?*

YESNON/ACL
Part Three: Description of Work*
19. Do you have up-to-date Fall Protection/Working at Heights training?*

YESNON/ACL
If you answer "No" to the question above your tasks must exclud working above 6 feet, working on any form of Elevating Work Platform, working in proximity to edges or anwhere a fall hazard exists.
20. Does your work involve connection or exposure to any building services?*

YESNON/ACL
20.a) If so select all that apply:

ElectricalWaterSprinklerSteamGasCommunication/Security/Controls
PSI Completed?*

YESNO
Additional Safe Work Procedures Attached?*

YESNO
Workers Name*
Workers Signature*
Escorts Name*
Escorts Signature*
Facilitators Name*
Facilitators Signature*
Legend: N/A = Not Applicable/CL = Client

NOTE: ALL SHORT DURATION WORKERS MUST SIGN IN AND SIGN OUT AT THE PROJECT OFFICE EACH DAY

Non-compliance to this site requirement will result in the use of PCL's disciplinary policy
Should be Empty:

Part Two: Incident Management