Orientation Date Requested:______Carmon CreekProject
Re: Site Access / Return to Work (after 90days)
To: Carmon Creek / Training Departmentemail to
The following personnel have met the pre-established site access conditions and are in compliance with the Site Access and / or Return to Work requirements set by the Carmon CreekProject. I understand D&A tests must be done within 90 daysprior to arriving on site unless they have been in continuous employment on another participating Shell site.Shell Carmon Creek Projectwill audit Companies to verify the existence and execution of a program in compliance with the project site access requirements.
Employee Name /Craft code or Office
/Date of Birth
/A&D
Site Access Test
/If applicable stipulate Shell participating site
/Construction Safety Training System
(CSTS)
/ Medical Clearance(fit for Work) / Photo ID Check
Month /Day
/ Date of Test / Note:Test must be valid within 3 years / CSTS Certificate Number / Date of Course / Date of test / HSSEUSE
Company:Sub: Contact Phone Number:
Name of Company Representative: Signature:
Title of Company Representative: Date:
Shell Approval Signature: _____ Print name:
Date: Title:
Contractors are responsible to ensure employees have completed the D&A requirements before Orientation, and prevent anyone that does not meet the compliance requirements from attending Orientation. A copy of all Safety Training Certificates must be submitted at orientation or with this application for entry into our data base. Orientation is held on Tuesday’s and Wednesday’s starting at 7:30am unless notified. Government photo ID is required. Please allow 2 working days for approval to book into Orientation. Confidentiality Statement:
Shell respects your privacy and is committed to protecting the personal information that you share with us. We are collecting your personal information for the purpose of tracking and verifying satisfactory completion of training requirements in order to ensure the health and safety of workers on our sites.If you misplace or lose your certificate Shell has the ability to identify you based on the information you provide for use on any Shell jobsite, therefore the information must be accurate. Your personal information may be disclosed to other Shell companies and to third party organizations outside of Canada that provide administration or other services. Shell will ensure that your personal information is protected in accordance with applicable law. If you have any questions or concerns regarding the above, please contact Shell Canada’s Privacy Officer at