Visitor Induction Form

Site Address *

Item 1. Discuss General Layout Of Site

Conducted? *

Yes

Item 2. Identify First Aid Cabinets/Kits

Conducted? *

Yes

Item 3. Telephone & Emergency Numbers

Conducted? *

Yes

Item 4. Emergency Radio Frequenceies

Conducted? *

Yes

Item 5. Emergency Exits & Muster Points

Conducted? *

Yes

Item 6. Fire & Safety Equipment Locations

Conducted? *

Yes

Item 7. Potable Water Points

Conducted? *

Yes

Item 8. PPE Requirements For Site

Conducted? *

Yes

Item 9. Out Of Bound Areas On Site

Conducted? *

Yes

Item 10. Identify Specific Hazards To Site: Vehicles, Chem, etc.

Conducted? *

Yes

Advisor Initial *

The following questions to be acknowledged by the visitor.

Item 11. Are you fit for work?

Conducted? *

Yes

Item 12. Are you taking any medication? Med Dec Form.

Conducted? *

Yes

Item 13. Are you capable of walking over undulating ground?

Conducted? *

Yes

Item 14. Are there any health issues that may compromise your safety on site?

Conducted? *

Yes

Item 15. Prohibited Substance: Firearms, Drugs/Alcohol

Conducted? *

Yes

Item 16. Actions on reporting incidents

Conducted? *

Yes

Visitor Initial *

Item 17. BAC Test Conducted

Conducted?

Yes

.

No

BAC Reading: *

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Visitors Name *

Signature *

Clear

Date *

Visitors Business

Person Conducting Induction Name *

Signature *

Clear

Date *

Receive A Copy Via. Email (Optional)

Please enter your email address above to receive a copy of the docket. (Optional)

The following questions to be acknowledged by the visitor.

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