Visitor Site Orientation Checklist
HSE Orientation and Training Standard HSE-03-04
Company
*
Orientation Date
*
/
Year
/
Month
Day
Date
Project Number
*
Project Name
*
Visitor's First and Last Name
*
1. Has a review of the Emergency Response/Project Site Plot Plan been completed?
*
Yes
No
N/A
2. Has the 6 foot 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 site requirements for the use of the following protective equipment been reviewed?
*
Yes
No
N/A
5.1 What personal protective equipment is required?
*
Safety Glasses
Gloves
Hearing Protection
Safety Footwear
Dust Mask
Respiratory Equipment
Hard Hats
Face Shields
Mono-Goggles
Fall Protection
Vests
Other
Part 2: Orientation AcknowledgmentThis form will be retained on file at the project worksite location
Visitor's Signature
*
STOP. Please hand phone/tablet to Nordic PCL employee for completion.
Escort's Name
*
Facilitator's Name
*
Escort's Name
*
Please Select
Blake Nelson
Lawrence Figueroa
Maryna Martyn
Escort's Signature
*
Facilitator's Name
*
Please Select
Blake Nelson
Lawrence Figueroa
Maryna Martyn
Facilitator's Signature
*
Preview PDF
Submit
Should be Empty: