‘Company Representative Visitor Phone # Company Purpose of vst Date: Time In: ‘Gam O pm Time Out: ‘Dam O pm | have received a Site Orientation and understand the following: Site Specific Hazards ‘Site Emergency Procedures Personal Protective Equipment (PPE) Requirements Rostrictod Aroas ‘Smoking Aras Applicable Safe Work Procedures Gonoral Site Safely Rules. Other oooooo00 Initial {will report any safety concerns to the superintendent or safety Coordinator prior to leavina the site. | understand that | am to keep my PPE on at. | undorstand | am not to go into aroas that! have not boon givon authority to ontor. | understand that | am to stay with my designated guide a all imes while on this ste, | understand where | am to goin the event of an emergency. | understand what my obligations are with regards 10 injuries sustained while on this site. times, By signing below you acknowledge that you have been orientated to the safety requirements of this sie and your expected conduct while on this site. You also acknowiedge that you will ‘comply withthe WorkSafeBIC Roguation and our OH8S program and all site rues. Varron SexaTune ‘Courant Rernesewtanve SGNATURE