New Employee Orientation Questionnaire SAMPLE #1. You may need to revise this form to suit your business needs. This section of your manual should contain a policy, an employee orientation process, a process for maintaining employee training records, and template safety meeting/toolbox meeting forms.

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New Employee Safety Orientation Questionnaire

SAFETY ORIENTATION QUESTIONNAIRE
Name of worker Date/Time
(Please Print)
Project name
Project location
Note: Place  by correct response:
1.Hazard identification and control is important to maintain a safe working environment.
No:Yes:
2.Working safely is a condition of employment.
No:Yes:
3.All injuries, regardless how minor, must be reported immediately to your supervisor.
No:Yes:
4.It is important to maintain good housekeeping in your work area.
No:Yes:
5.You observe an unsafe condition on site, should you:
Wait for the weekly tailgate safety meeting and report it.
Report it immediately to your supervisor.
Let someone else worry about it.
6.It is permissible to carry material or equipment up or down any access ladder?
No:Yes:
7.Openings that are covered with plywood will have the plywood secured to prevent accidental dislodgement and will be marked with:
A circle
A cross
Letters warning of the opening
All of the above
8. A trench is 6 feet deep. It is permissible for you to enter the trench to work if it is not cutback or shored?
No:Yes:
9.Personal protective equipment (hearing protection, fall protection, eye protection) should be worn whenever:
Someone else is wearing it
Your supervisor advises you to wear it
The potential for personal injury exists
10.When you are working from heights, and guardrails are missing, you must use fall arresting equipment.
No:Yes:
11.Tools and equipment whose guards are inoperative or missing are okay to use `just this once'.
No:Yes:
12.The Workplace Hazardous Material Information System (WHMIS) designates certain products as controlled products and require them to be labeled. This label is a warning for you the worker. The label tells you the:
Name of the product
Hazard symbol
Risks when you use it
Personal protective equipment to wear
First aid treatment if necessary
All of the above
13.Material Safety Data Sheets (MSDS) are also required for WHMIS controlled products. These sheets are readily available for your additional information by asking your supervisor to see them.
No:Yes:
Signature of worker: