Visitor's HSE Induction Form

Project Name:
________________________________________

Date:
________________________________________

Visitor's Name:
________________________________________

Company:
________________________________________

Purpose of Visit:
________________________________________

Visitor's Contact Number:

________________________________________

Escort's Name:
________________________________________

Escort's Contact Number:

________________________________________

Safety Instructions
Item Yes No

Has the visitor signed in at

the entrance?

Is the visitor wearing the

required PPE (Safety
helmet, safety glasses,
safety boots, high visibility
vest, long sleeve shirt)?

Is the visitor escorted by a

designated staff member at
all times?

Has the visitor been

instructed to follow all
safety signs and
instructions from the staff?

Is the visitor refraining

from operating any tools or
equipment?

Is the visitor avoiding

restricted or hazardous
areas without
authorization?

Is the visitor refraining

from bringing prohibited
items into operational areas
(e.g., mobile phones,
ignition sources, closed
bags, backpacks)?

Has the visitor been

informed of the emergency
assembly points and
evacuation routes?

Has the visitor been

instructed on what to do in
case of an emergency?

Has the visitor been

informed not to re-enter the
site until it is declared safe?

Has the visitor been shown

the hazardous areas and no-
go zones?

Has the visitor been shown

the location of first aid
facilities and emergency
contact numbers?

Has the visitor been

informed about the
provisions for emergency
communications?
Has the visitor been shown
the crib facilities, drinking
water, and toilets?

Has the visitor been

informed about the
emergency and firefighting
equipment?

Has the visitor been

instructed to report any
accidents, incidents, or near
misses immediately?

Has the visitor been

informed about
participating in incident
investigations if required?

Is the visitor aware that

smoking is prohibited
except in designated
smoking areas?

Is the visitor ensuring long

hair is tied back and any
hoods are down in
operational areas?

Is the visitor maintaining a

safe distance from moving
vehicles and heavy
equipment?

Is the visitor aware of and

avoiding pinch points and
other mechanical hazards?

Is the visitor refraining

from using any substances
that are considered
hazardous?

Is the visitor refraining

from littering and using
designated waste disposal
containers?

Has the visitor been

instructed to report any
environmental spills or
hazards immediately?

Is the visitor following site-

specific environmental
policies and guidelines?

Has the visitor informed the

escort of any medical
conditions that may require
attention?

Is the visitor aware of the

locations of the nearest
restrooms and hydration
stations?

Has the visitor been

instructed to take regular
breaks in designated areas
to avoid fatigue?

Declaration
I have read and understood all the above instructions:

Visitor's Signature:
________________________________________

Escort's Signature:
________________________________________

Date:
________________________________________

Emergency Contact Numbers

Police: ________________________________________

Ambulance: ________________________________________

Civil Defense: ________________________________________

Fire and Rescue: ________________________________________

First Aid Room: ________________________________________

Project Manager: ________________________________________

HSE Officer: ________________________________________

First Aid Room is located at:

________________________________________