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:
________________________________________
