General Orientation Questionnaire

/ Form 000.653.F0152
General Orientation Questionnaire
Date:
Name:
Classification
Employer:
Instructions to Attendees

Complete the following questionnaire by circling the letter representing the correct answer.
If you have a question or are unsure of the question – ask the trainer.
There is no time limit – so take your time.
When you have finished the test, move outside and wait for further instructions.

Do not leave without permission from the trainer.

Who has primary responsibility for your well-being (i.e., safety)?

(a)You
(b)Your supervisor
(c)Your HSE Representative

You should immediately report injuries/incidents to?

(a)Coworker
(b)Supervisor
(c)HSE Representative

Which of the following eye protection should you wear when on the project/site?

(a)Safety glasses with side shields
(b)Ordinary sunglasses
(c)Ordinary prescription glasses
(d)It is a matter of personal choice

100percent tie off using a safety harness and shock-absorbing lanyard is required:

(a)When you are not within the handrails of a work platform and you could fall and injure yourself, or you are in an elevating work platform
(b)If you are not a rigger
(c)When you think you need it
(d)(a) and (c)

What is the site emergency phone number?

______

If, when preparing to use any equipment, you discover that it is defective or has an out-of-date inspection tag, you should:

(a)Try to make necessary repairs
(b)Go ahead and use it because the job has to get done
(c)Use another employee’s tool
(d)Attach a completed Out of Service tag and return it for inspection

Container labeling and material safety data sheets (MSDSs) are two requirements of the Hazard Communication program. To obtain access to anMSDS you must:

(a)Submit a request in writing
(b)Contact the Project Manager first
(c)Ask your supervisor for it

What is the maximum speed limit for all light vehicles on the construction site?

______

Which of the following is the only correct way to dispose of waste oil?

(a)Tip it in a remote location on the site where people do not usually go
(b)Spread it around to keep the dust down
(c)Tip it into a clearly labeled drum set aside for the purpose so that it can be collected and removed from the site

All personnel are required to wear trousers, collared shirts, hard hats, safety glasses, and steelcapped boots:

(a)In all site areas except offices, mess rooms, or toilet blocks
(b)All outdoor areas around the plant and construction site
(c)Only where it is sign-posted

If you have a concern over anHSE matter, you should:

(a)Raise it at the next toolbox meeting
(b)Get someone else to raise the matter
(c)Raise it with your supervisor as soon as practicable

Is it necessary for portable electrical equipment to be inspected and tagged?

(a)Yes
(b)No

In your own words, describe what the site requirements are for personal protective equipment. (start from the feet and work your way up the body)

______
______
______

How often should you inspect your tools and equipment?

(a)Prior to use
(b)Weekly
(c)Monthly

Harassment includes:

(a)Insulting people due to their race or religion
(b)Telling sexually explicit jokes
(c)Unwanted physical contact
(d)All of the above

When working in hot climates, what do you need to do?

(a)Drink plenty of water
(b)Use sunscreen
(c)Wear the correct clothing
(d)All of the above

Warning signs are in place for what reason?

(a)It is a legislative requirement
(b)To continually warn people of danger
(c)(a) and (b)
(d)They look nice and brighten the place up a bit

Employees may be subject to disciplinary action. What are the reasons for this?

(a)They may have endangered themselves and/or someone else’s well-being
(b)They may have deliberately broken the project requirements
(c)All of the above

An Employee Assistance Program is available for all employees of the project. Under what circumstances can you use the help line?

(a)To talk to someone regarding a personal issue
(b)To discuss potential addictions and/or receive advice on alcohol and drugs
(c)To discuss any issue with a trained professional counselor
(d)All of the above

Employees must attend a pre-task meeting. When are these meetings held?

(a)Monthly
(b)Weekly
(c)Daily

Employees must attend a safety toolbox meeting. When are these meetings held?

(a)Monthly
(b)Weekly
(c)Daily

Fitness for work is defined as:

(a)Being suitably rested and free of fatigue
(b)Having a breath alcohol content(BAC) reading below 0.5
(c)Not being under the influence of any drug, legal or otherwise
(d)All of the above

When would you stop work, make the area safe, and notify your supervisor?

(a)When it is unsafe
(b)When a coworker is about to endanger himself and/or others
(c)(a) and (b)

Traffic Management has been designed to protect your safety. What are some of the basic rules?

(a)Obey all road signs and warning signs, and be a designated driver
(b)Have a BAC reading below 0.5 and not be under the influence of any other drug
(c)Inform your supervisor when and where you are driving to
(d)All of the above

A designated driver is someone qualified to operate a vehicle on site. To attain this authority, what would they have to complete?

(a)A current driver’s license
(b)An approved driver’s course
(c)An application with their qualifications attached
(d)All of the above
Message Received – Project Orientation
I have been trained, tested, and understand the project-specific requirements.
Attendee Name (print):
Attendee Signature:
Trainer Signature:
Message Received – Contractor-Specific Orientation
I have been trained, tested, and understand the project-specific requirements.
Attendee Name (print):
Attendee Signature:
Trainer Signature:
Message Received – Area-Specific Orientation
I have been trained, tested, and understand the project-specific requirements.
Attendee Name (print):
Attendee Signature:
Trainer Signature:

Instructions:

At the completion of each phase of the orientation, you and your supervisor are required to sign each of the relevant areas.
This will indicate that you have been trained in accordance with the project HSE Management System.
On completion of the orientation questionnaire, hand the form to your supervisor, who will return it to the HSE Representative.
If at any time you are unsure of anything you are being told or shown, do not hesitate to ask.

Note:This form is referenced in Practice000.653.1001.