| Worker Name (print) |
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| Company / Employer |
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Date |
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| Project Address |
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DOB Job No. |
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| SST Card No. |
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SST Expiration Date |
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| SST Card Verified By |
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Language of Orientation |
English
Spanish
Other: _______
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1. Personal Protective Equipment (PPE) — OSHA 1926.95
- Hard hat (Class E minimum) is required at ALL times on this construction site — no exceptions
- Safety glasses or goggles required in all active work areas and wherever overhead work is in progress
- High-visibility vest (ANSI Class 2 minimum) required when working near moving equipment or vehicle traffic
- Steel-toed work boots or equivalent protective footwear required at all times
- Gloves, hearing protection, and respiratory protection required per specific task and as directed by foreman
I understand and agree to wear all required PPE at all times on this site.
2. Fall Protection — NYC BC §3315 / OSHA 1926.502
- Fall protection is required for any work at or above 6 feet — no exceptions
- Guardrails, personal fall arrest systems (full-body harness + lanyard), or safety nets must be used
- Floor openings must be covered, secured, and marked — NEVER remove a floor cover without authorization from SSM
- Ladder safety: maintain 3-point contact at all times, secure top and bottom, never overreach or carry materials while climbing
- Double-lanyard (100% tie-off) required when moving between anchor points on suspended scaffold
I understand fall protection requirements and will use PFAS whenever working at or above 6 feet.
3. Hot Work & Fire Prevention — NYC FC §105.6 / OSHA 1926.352
- No welding, cutting, grinding, or torch operations without a written FDNY Hot Work Permit
- A fire extinguisher (minimum 10-lb. ABC) must be present at the hot work location at all times
- Fire watch is required for a minimum of 60 minutes after completion of all hot work
- Absolutely no smoking anywhere on this site — "No Smoking" signs are posted at all entries
- Flammable liquids stored in approved safety containers only — no open containers on site
I understand hot work and fire prevention requirements on this site.
4. Scaffolding & Elevated Work Platforms — NYC BC §3316 / BC §3317
- Supported scaffold access requires a valid 4-hour scaffold safety training card
- Suspended scaffold access requires a valid 16-hour suspended scaffold training card
- NEVER access a scaffold that has been red-tagged, taken out of service, or is missing planks or guardrails
- Report any scaffold damage, instability, or missing components to the SSM immediately — do not attempt repair yourself
- Aerial lifts and scissor lifts: trained and authorized operators only; full-body harness required in platform
I understand scaffold and elevated work platform safety requirements on this site.
5. Housekeeping & Material Storage — NYC BC §3309
- Keep your work area and all walkways clear of debris, tools, and tripping hazards at all times
- Materials must be stored a minimum of 10 feet from open floor edges (5 feet where perimeter is under 1,000 SF)
- Combustible debris must be removed from all floors daily — no overnight accumulation
- Never store materials in stairwells, egress corridors, or areas blocking emergency access
I understand housekeeping and material storage requirements on this site.
6. Hazard Communication (HAZCOM) — OSHA 1910.1200
- Safety Data Sheets (SDS) are maintained in the site field office for every chemical on site
- Read the SDS before handling any chemical or hazardous material for the first time
- All containers must be labeled — never use an unlabeled container or transfer chemicals to unlabeled bottles
- Report all chemical spills immediately to your foreman and the SSM
I understand hazard communication requirements and know where to find SDS binders on this site.
7. Emergency Procedures
- Emergency Assembly Point: ___________________________________ (SSM will brief you at the end of orientation)
- FDNY Emergency: 911 | Site Foreman: __________________ | SSM: __________________ | First Aid: __________________
- Know the location of: Fire extinguishers · First aid kit · Nearest exit · Nearest phone
- Injury on site: DO NOT move the injured worker. Call 911, then immediately notify your foreman and the SSM
- In a fire: activate the nearest pull station, call 911, proceed to assembly point — do NOT use elevators
I understand the emergency procedures for this site and know the assembly point location.
8. Site Disciplinary Policy & Zero Tolerance
- 1st Violation: Written warning issued by SSM — documented in daily log
- 2nd Violation: Removal from site for the remainder of the work day
- 3rd Violation / Serious Violation: Permanent removal from the project — no reinstatement
- Zero Tolerance: Working under the influence of drugs or alcohol results in immediate, permanent removal from the project
- Zero Tolerance: Removing, bypassing, or disabling any safety device, guardrail, or floor cover results in immediate removal
I understand this site's disciplinary policy and zero-tolerance rules.
Worker Acknowledgment & Signature
"By signing below, I certify that I have received, read (or had fully translated to me), and understood this safety orientation in its entirety. I agree to comply with all site safety rules, NYC Building Code Chapter 33 requirements, and all applicable OSHA regulations."
| Orientation Conducted By (print) | | SSM License No. | |
| SSM Signature | | Date | |
| Translator Name (if applicable) | | Language Translated | |
| Translator Signature | | Date | |