New Worker Orientation
Health & Safety Checklist · Form #NWO-02
Worker Information
Address
Phone Number
Occupation
Years of Experience
Direct Supervisor
Supervisor Phone
Orientation Conducted by
Emergency Contact
A young worker is anyone under 25 years old — are you a young worker?
Young Worker Information (Under 25)
Young workers are more at risk of injury. Please initial each section after review.
Your Health & Safety Rights
Right to know about hazards in the workplace
Right to participate in health & safety activities
Right to refuse unsafe work without punishment
Must immediately report injuries to supervisor
Responsible to report any safety concerns
Responsible to not perform untrained tasks
Your Employer & Supervisor
Employer ensures health & safety of all workers
Employer remedies hazardous conditions
Employer establishes safety policies & programs
Employer provides PPE and ensures its use
Supervisor ensures health & safety of workers
Supervisor must be knowledgeable about OHS
Your Responsibilities
Follow procedures and ask supervisor when unsure
Do not create hazards that could harm others
No horseplay or conduct that endangers others
No harassment or bullying - report conditions
Cooperate with safety reps and committees
Training Definition
Training = verbal instruction + demonstration
First time: supervisor SHOWS you how
Then you SHOW supervisor you can do it
Must be trained before hazardous tasks
I acknowledge that I have reviewed the young worker information above and understand my rights, responsibilities, and the training requirements.
Site Policies, PPE & Hazards
1. Site Policies
Disciplinary Action Policy
2-Way Radio Etiquette
Traffic & Noise Bylaw
Alcohol, Drugs & Impairment
Defective Equipment/Tools
Bullying & Harassment
Hazardous Materials
Working Alone
OH&S Compliance
Falling Objects Prevention
2. Personal Protective Equipment
CSA/ANSI Standards
Hard Hat & Boots
Clothing & Vest
Safety Glasses
Hearing Protection
Respiratory Protection
2. PPE (Continued)
Gloves
Coveralls
PPE Fitting/Inspection
Manufacturer Instructions
Specialized PPE
3. Site Hazards
Working near equipment
High voltage power
Overlapping work zones
Rebar protection
Ladder safety
Working at heights
Scaffolding
Concrete work
Confined spaces
Floor openings
Electrical safety
Formwork stripping
Loading/Unloading
Manual lifting
Crane operations
Silica dust
Control zones
Safety Rules & Rights
4. Safety Rules
Disciplinary Policy
Smoking/Vaping
First Aid Locations
JOHS Committee
OHS Program Location
Emergency Procedures
SDS Location & Spills
Warning Tape/Signs
Public Interaction
Silica Processes
Health Rules
Escape Routes
ASK Supervisor
Fire Extinguishers
WSBC Regulations
5. Rights & Responsibilities
Right to Refuse Unsafe Work
Right to Know Hazards
Right to Participate
Right to Competent Supervisor
Follow Safety Rules
Participate in FLHA
Use Authorized Equipment
Report Hazards
Clean Up Work Area
Correct Unsafe Conditions
Control Hazards
Duty to Work Safe
Respect Property
Use Facilities Properly
6. Training Status
| Training / Ticket | Not Needed | Email Proof | Have Proof | Don't Have |
|---|---|---|---|---|
| WHMIS | ||||
| Respirator Fit Test | ||||
| Hearing Test | ||||
| Fall Protection | ||||
| Rigging & Hoisting | ||||
| Mobile Equipment | ||||
Select one option per training item
7. Medical Information (Optional)
Heart or lung condition?
Allergies to food/drugs?
Chronic conditions?
Current medications?
8. Worker Acknowledgment
I acknowledge that I have received, understood, and will follow all information presented during this orientation. I understand my responsibilities for my health and safety on this worksite. I also agree to participate in my Employer's Injury Management/Return to Work Program, and any other Health and Safety activities.
Signatures
Worker
Signature
No signature on file
Orientator
Signature
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