SITE SPECIFIC SAFETY
PART 2. COMPLETE ALL SECTIONS ONCE PART 1: NEW WORKER HEALTH
AND SAEFTY ONLINE ORIENTATION HAS BEEN COMPLETED.
Name of Worker:
Job Title: Department:
Start Date at Location: Date of Safety Orientation:
Name of Direct Supervisor/Manager: Name of Orientation Provider:
Reason for Orientation:
a NAME AND CONTACT INFORMATION FOR SUPERVISOR
I have been advised of my Supervisor’s name and contact information.
b JOINT OCCUPATIONAL HEALTH AND SAFETY COMMITTEE ( JOHS COMMITTEE)
I have been advised on how to contact the committee, and have been made aware of a local worker representative on the
c WORKPLACE HEALTH AND SAFETY RULES
I have been trained on the specic workplace safety rules related to my work/work area.
d WORKER’S RIGHTS AND RESPONSIBILITIES
I have been advised on my rights and responsibilities as a worker.
e POTENTIAL HAZARDS OF A WORKPLACE
I have been advised about the hazards that may be encountered while performing my work tasks.
f PERSONAL PROTECTIVE EQUIPMENT (PPE) (IF APPLICABLE)
I have received the appropriate orientation and training in the use and care of any PPE or clothing that is required to safely
perform my work. Required PPE has been provided.
g EMERGENCY PROCEDURES
I have been advised of the emergencies that could occur and the procedures to follow.
h FIRST AID
I know the number for rst aid at my campus.
i ACCIDENT INCIDENT REPORTING AND INVESTIGATION
I am aware of the incident reporting procedures.
j VIOLENCE IN THE WORKPLACE
I have been advised of any potential risk for violence in the workplace.
k WORKING ALONE OR IN ISOLATION (IF APPLICABLE)
I have been trained on the policies and procedures to be followed for working alone or in isolation.
New Hire Restart after Absence Change of job within Selkirk College or Relocation to new workplace