SITE SPECIFIC ORIENTATION

Checklist and Quiz

Worker Name (Print): Certification #:

Employer: Years of Experience:

Trade: Emerg. Contact #:

Mailing Address:

Introduction Personal Protective Equipment

Explanation of project & duties Hard hats regular workers - mandatory - Class E, Type 1, Minimum
Review of Subcontractor Safety Booklet Hard hats new workers (<2yrs) Mandatory GREEN Class E, Type 1, Min
Safety Board overview Foot wear - mandatory - CSA (Green Patch)
Eye protection - mandatory - CSA approved
Mandatory Training Hand protection - mandatory - MRCL to carry ANSI Cut Level 4 min.
WHMIS Hearing protection - approp. to the circumstances
MOL H&S Awareness training (Worker/Supervisor) or Equivalent Breathing/respirators - approp. to the circumstances
Elevating work platforms Fall protection - mandatory when required (O.Reg. 213/91 S. 26)
Explosive actuated fastening tools Fall protection - Hierarchy of Controls
Fire Extinguisher High Visibility Garment - appropriate to the circumstances
Heavy Equipment - Maple Reinders Skills Checklist
All other applicable training as required Equipment Safety
Working at Heights Designated Operators - Maple Reinders/Subcontractor
Copies of all records of training, C of Q, etc. Pre-Use Inspection
Equipment maintenance logs / operator's manuals
Safety Legislation, Occupational H &S Act, Regs Equipment operation / moving equipment / load charts
Duties supervisors (Act S. 27) Signalling
Competent Person defined (Act Definitions 1(1)) 100% Tie Off Required in ALL EWPs
Duties workers (Act S. 28)
Competent Worker defined (Reg. Definitions 1(1)) Site Access/Egress
H & S Rep. / JHSC (Act S. 8, 9) Site entrance and parking
First Aiders (Workplace Safety & Insurance Act Reg. 1101) Daily sign-in by each individual
Safe access & egress to and from area
Hazard Assessment & Control Emergency egress
JHA/FLHA - Superintendent/designate review
JHA/FLHA - Supervisor sign off Electrical
WHMIS (legislation, training, labels, SDS binder) Overhead Wires (signage, spotter)
Underground Utilities (locates, hand dig expos.)
Reporting Panels
Injury/Incident / Near Miss reporting procedures Extension cords
Property damage
Critical Injury defined R.R.O. 1990 Reg. 834 Traffic Control OHSA O.Reg. 213/91 S. 67, 68, 69
Modified Light Duty Policy Protective measures general (S. 67)
Traffic protection plan (S. 67(4))
Emergency Procedures Set up / removal (S. 67(6))
Review of ERP - ALL CONTENTS Traffic signs (S. 68)
Evacuation Air Horn Signals (site specific) Traffic control persons (S. 69))
Security Protective clothing (S. 69.1)

General Rules Personal Hygiene

Review of Site Rules (i.e. Earbuds, Smoke Free Act, etc.) Toilets & clean-up facilities
Review of Alcohol & Drug Use Policy Lunchroom
Review of Workplace Violence & Harassment Policy
Availability of Safe Work Practices and Procedures
Progressive Disciplinary Action Policy Maple Reinders HSE Manual - Procedures & Risk Registry
Verbal warning
Written warning Site Specific
Administrative penalties Covid Prevention Measures
Removal from site and administrative penalties Competent Person in Charge
Automatic removal from site Competent Operators and Owner's Manual knowledge

**FILE ON SITE**
Maple Reinders
Issued: January 01, 2022 Rev 0 Form 2

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 Quiz Questions

✔ Refuse unsafe work / Participate /

A worker has the right to... (Select
1 :
the right box)
✔ To Know / Work Alone /

✔ Safety Glasses / ✔ CSA Boots / ✔ High Vis Vest /

What is the mandatory PPE needed for this project?
2 :
(Select the right box)
Gloves / ✔ Hard Hat

Job Box / Lunch Trailer /

Where would you can find a copy of the Occupational Health and Safety
3 Act and Regulations on this project? (Select the right :
box)
Memo Board / ✔ Safety Board /

✔ Hazard Assesment / Pre-Use Inspections /

What should be filled out before you start work? (Select
4 :
the right box)
✔ Active Screening

: Job Box / Lunch Trailer / ✔ Safety Board /

Where would you find a map to the hospital? (Select
5
the right box)
Memo Board

Leave it alone / ✔ Report it to a supervisor /

What should you do if you discover a defective tool or an unsafe
6 :
condition on site? (Select the right box)
Talk about it at a safety meeting

Near Miss / ✔ Covid Symptons /

You are responsible for reporting what to your supervisor? (Select the
7 :
right box)
✔ Hazards / ✔ Injuries and Incidents

Your vehicle / Center of the project /

8 Where should you go during an emergency on site? (Select
: the right box)
✔ Muster Point / Office trailer

Job Box / Lunch Trailer / ✔ Safety Board /

Where would you find the Safety Data Sheet binder? (Select the
9 :
right box)
✔ Safety Board / Memo Board

Someone with
Anyone / A competent operator / ✔
Who may operate powered mobile equipment on this project? (Select experience
10 :
the right box)

This is to acknowledge that I have reviewed the Maple Reinders Health and Safety Policies. I understand and agree that I must have knowledge of the
safety policies, rules and regulations that apply to my work. I must comply with site and company safety rules along with all governing Acts and
Regulations as part of my personal responsibility towards safety on the job. I have received a site specific orientation and agree to work in compliance
with all governing legislation, Maple Reinders Health and Safety Program as well as my own Company Health and Safety Program. I acknowledge a copy
of the Health & Safety Policy is posted on the site safety board and available to me for reference.

Orientation Performed Worker

by: Signature: Hitesh vaghasiya

Orientator's Signature: Date: 07 may 2023

Project Name / Number: james snow business park

Issued: January 01, 2022 Rev 0

Maple Reinders Form 2

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