ORIENTATION - HR Forms & Safety Video Step 1 of 9 11% Welcome to the Company Safety Orientation for Barrack Energy Services Ltd.*Please follow the prompts and directions to complete the digital portion of your orientation by selecting the option below that applies to you: EMPLOYEE CONTRACTOR - OWNER CONTRACTOR - CREW MEMBER COMPANY/OWNER INFORMATION:* Company Name CONTRACTOR INFORMATION: Company Name* CONTRACTOR INFORMATION: Company Owner* PERSONAL INFORMATION:* First Name Last Name Date of Birth:* Month Day Year Email:* Enter Email Confirm Email Cell Phone Number:*Alternative Phone Number:Address:* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code COMPANY INFORMATION: Business/GST Number* COMPANY INFORMATION: WCB Number* COMPANY INFORMATION: Insurance Provider* COMPANY INFORMATION: Insurance Policy Number* EMERGENCY CONTACT #1* First Name Last Name Relationship to Contact* Phone Number*Email EMERGENCY CONTACT #2 First Name Last Name Relationship to Contact Phone NumberEmail ADDITIONAL INFORMATION:Please include any pre-existing medical conditions Barrack Energy Services should be aware of;If conditions are present, please list corrective measures or prescriptions (i.e.: EpiPen, glasses, prescribed medication/s).If conditions are present, please list corrective measures or prescriptions (i.e.: EpiPen, glasses, prescribed medication/s). BANKING/DIRECT DEPOSIT INFORMATION:*Name of Financial Institute Direct Deposit Form or Void ChequeYou can upload a copy of your direct deposit form or void cheque here. Max. file size: 100 MB.EMPLOYEE INFORMATION (continued)*I understand that my employee compensation (wages, vacation and any payments made) are to remain confidential in nature and constitute a contract between myself and Barrack Energy Services. I agree that this information is to remain confidential and is not to be shared among other employees. Sharing or discussing of personal compensation could result in disciplinary action up to and including dismissal. I hereby authorize Barrack Energy Services to initiate automatic deposits to my account at the financial institution named above. I also authorize Barrack Energy Services to make withdrawals from this account in the event that a credit entry is made in error. Further, I agree not to hold Barrack Energy Services responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. This agreement will remain in effect until Barrack Energy Services receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department. I declare that the information given is true and accurate to the best of my knowledge.CONTRACTOR INFORMATION (continued)*I hereby authorize Barrack Energy Services Ltd to initiate automatic deposits to my account at the financial institution named above. I also authorize Barrack Energy Services Ltd. to make withdrawals from this account in the event that a credit entry is made in error. Further, I agree not to hold Barrack Energy Services Ltd. responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. This agreement will remain in effect until Barrack Energy Services Ltd. receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department. I declare that the information given is true and accurate to the best of my knowledge. EMPLOYEE ACKNOWLEDGEMENT: Work Availability*Barrack Energy Services employs workers on a project-based schedule. As oil and gas construction is primarily a seasonal industry, full time hours are not guaranteed to any person employed or contracted by the company. I understand and acknowledge the above regarding work availability.CONTRACTOR ACKNOWLEDGEMENT: Work Availability*Barrack Energy Services Ltd. employs workers on a project-based schedule. As oil and gas construction is primarily a seasonal industry, full time hours are not guaranteed to any individual or contractor. I understand and acknowledge the above regarding work availability.EMPLOYEE ACKNOWLEDGEMENT: PPE*Barrack Energy Services requires that all workers, or any person present at a site where work is being performed, must wear appropriate Personal Protective Equipment (PPE). Below is a list of the minimum PPE that is required to work at Barrack. You are responsible to provide your own basic PPE. Barrack is responsible for providing specialized PPE as required. • Hard Hat – in good condition within three years of manufacture. • Work Boots – work and environment appropriate, and CSA certified. • Safety Glasses – or goggles, must be in good condition, comply with OH&S standards (if you require eye glasses they may be adequate if worn with side shields. • FR Coveralls - must be fire retardant, have Hi-Vis markings, weather appropriate, and in good attention. • Gloves work and environment appropriate. I understand and acknowledge the above regarding PPE.CONTRACTOR ACKNOWLEDGEMENT: PPE*Barrack Energy Services requires that all workers, or any person present at a site where work is being performed, must wear appropriate Personal Protective Equipment (PPE). Below is a list of the minimum PPE that is required to work at Barrack. You are responsible to provide your own basic PPE. Barrack is responsible for providing specialized PPE as required. • Hard Hat – in good condition within three years of manufacture. • Work Boots – work and environment appropriate, and CSA certified. • Safety Glasses – or goggles, must be in good condition, comply with OH&S standards (if you require eye glasses they may be adequate if worn with side shields. • FR Coveralls - must be fire retardant, have Hi-Vis markings, weather appropriate, and in good attention. • Gloves work and environment appropriate. I understand and acknowledge the above regarding PPE.EMPLOYEE ACKNOWLEDGEMENT: Absenteeism*Barrack Energy Services expects all employees to report to work as scheduled and on time. All employees are expected to use responsible judgment when not reporting to work due to illness, accident, or an emergency. Procedure: 1) If unable to report to due to accident, illness, or an emergency, all employees are expected to call their immediate supervisor as much in advance of their start time as possible to allow time for their replacement to be secured. 2) Employees are expected to notify and obtain their foreman or supervisors’ approval for any planned or foreseeable absence from work. 3) Employees are encouraged to schedule medical, dental, and personal appointments outside of their working hours. 4) Any employee that does not notify their supervisor and get their permission to be absent from work shall be suspended from duty without pay until the absence is reviewed by management. Absenteeism is considered unacceptable behavior and will be handled according to the Disciplinary policy. I understand and acknowledge the above regarding absenteeism.EMPLOYEE ACKNOWLEDGEMENT: Barrack Owned Property*In the course of your employment with Barrack Energy Services you will be entrusted with and/or have access to various assets and materials/tools. It is a condition of employment that you will reimburse Barrack Energy if you fail to properly secure, protect and take care of those assets. You hereby agree to be payroll deducted: • $50 to replace fuel cards which were assigned to you if you are unable to return them, along with any costs charged to fuel cards because of abuse • $250 to replace lost key FOBs to the trucks, equipment, or shop • $850 to replace a 4-head monitor if you cannot return it in working order • $850 for a 2-way radio that (either whole or in various parts) you cannot return • Actual cost of a non-negative (failed) drug & alcohol test I understand and acknowledge the above regarding Barrack property.CONTRACTOR ACKNOWLEDGEMENT: Barrack Owned Property*In the course of your employment with Barrack Energy Services you will be entrusted with and/or have access to various assets and materials/tools. It is a condition of employment that you will reimburse Barrack Energy if you fail to properly secure, protect and take care of those assets. You hereby agree to have the following expenses deducted from your invoice: • $50 to replace fuel cards which were assigned to you if you are unable to return them, along with any costs charged to fuel cards as a result of abuse • $250 to replace lost key FOBs to the trucks, equipment, or shop • $850 to replace a 4-head monitor if you cannot return it • $850 for a 2-way radio that (either whole or in various parts) you cannot return • Actual cost of a non-negative (failed) drug & alcohol test I understand and acknowledge the above regarding Barrack property. EMPLOYEE MEDICAL ACKNOWLEDGEMENT FORM:*As your employer, Barrack Energy Services Ltd, is responsible for your health, safety and welfare while at work, therefore it is important that we are aware of any conditions, medical or otherwise, which may have an impact on you in the workplace. This is not designed as a tool to discriminate, rather to create awareness and ensure you are properly accommodated in the workplace. First Name Last Name ADDITIONAL INFORMATION:Please include any medical conditions Barrack Energy Services should be aware of (i.e.: allergies, heart problems, skin sensitivity, impaired vision, hearing loss, previous injuries, back, neck or limb injuries). If conditions are present, please list corrective measures or prescriptions (i.e.: EpiPen, glasses, prescribed medication/s).If conditions are present, please list corrective measures or prescriptions (i.e.: EpiPen, glasses, prescribed medication/s). UntitledIn case of an emergency, where do you keep your medications (i.e.: backpack, vehicle)? HEALTHCARE INFORMATION: Medical Doctor* Phone Number - Medical Doctor/Office*Healthcare Number* Province Healthcare Number Issued* AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Consent*All workers must advise their operations manager or safety manager if he/she incurs any injury or ailment that may affect fitness for duty. Safety can only be achieved with your complete cooperation. You owe it to yourself, your family and fellow workers to be fit for duty at all times. Barrack Energy Services will endeavor to assist employees to return to a fit for duty status as applicable. I certify that the statements herein are complete and accurate to the best of my knowledge. I have not withheld information pertaining to my physical or medical conditions.*Date* MM slash DD slash YYYY FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT (FOIP ACT)COLLECTION OF PERSONAL INFORMATION (S.33 FOIP ACT)*The information collected on the HR Form is personal information as referred to in the FOIP Act. Barrack Energy Services believes the information collected relates directly to and is necessary for the operations and procedures that are conducted by this business and to provide a safe and secure environment for all those employed and/or contracted by the company. I understand and agree to the above regarding the collection of personal information.USE OF IMAGES/VIDEOS*There are occasions where images are taken of workers in a shop or field setting for social media or publication purposes, where people may be identified by name, such as: photographs or videos of staff working or operating machinery, shots of project overviews and completed work. I grant permission to Barrack Energy Services to allow my picture to be used in the described manner. Yes No SAFETY ORIENTATION VIDEOPlease watch the safety video below and complete the following questions. You will not be able to proceed to the next page until the video has run through until the end. SAFETY COMPETENCY QUIZ1. The online orientation you recently viewed is a basic introduction of the rules, policies, and procedures at Barrack Energy Services Ltd. For a more in depth understanding you can access the full HSE Manual by request from your Supervisor.* True False 2. Prior to performing any work, all workers assigned to that task are required to fill out and sign a Field Level Hazard Assessment Form (FLHA).* True False 3. To operate a skid steer, zoom boom or AWP, I must first have a valid ticket from a recognized course.* True False 4. Barrack Energy has a zero-tolerance policy for being under the influence of any drugs or alcohol while on duty.* True False 5. If I am grinding, buffing, or performing a task that creates flying debris, I must wear a face shield as well as CSA glasses.* True False 6. If I am injured performing a task at work, I must report this immediately to my supervisor or Workers Compensation Board (WCB) may refuse my claim.* True False 7. Before I use a safety harness with a lanyard, I must fill out harness inspection card provided by Barrack Energy Services.* True False 8. If any of my required safety tickets expire, it is up to me to renew them and keep them current/valid.* True False 9. Signing in to daily tailgate meetings is a requirement so that in the event of an emergency/muster situation, I will be accounted for.* True False 10. If I am unsure of a directive given to me, I will ask for clarity so that I understand my task.* True False 11. Personal Protective Equipment (PPE) should be worn;* whenever you enter a work area and see someone else is wearing it whenever your supervisor advises you to wear it whenever the potential for personal injury exists in the shop at all times all of the above 12. It may not be OK with the safety officer around here to remove or modify guards on my tools and equipment, but it is not against the law. Removing guards or modifying them to make tool use easier is just common sense.* True False 13. Smoking is permitted in company vehicles, as long as nobody objects, and the window is down.* True False 14. Safety is everyone’s responsibility.* True False 15. I do not have to submit to and cooperate with audits and inspections and I do not have to obey supervisors or the safety officer unless I choose to.* True False 16. I have the obligation to refuse unsafe work. I could be held accountable for failing to assert and obey this obligation under the law.* True False 17. I must supply my own basic PPE, but Barrack Energy Services. will supply Specialized PPE.* True False 18. The speed limit in the Barrack Energy Services yard/site is 30 km/hour.* True False 19. Workers on all job sites are required to participate in the hazard assessment process.* True False 20. Violence of any nature will not be tolerated at Barrack Energy Services.* True False SAFETY POLICY AGREEMENT*Please select the policies that were reviewed during your safety orientation: Select All Health and Safety Policy Personal Protective Equipment (PPE) Policy Preventative Maintenance Policy Discipline Policy Inspection Policy Incident Investigation and Reporting Policy Drug and Alcohol Policy Communication Policy Workplace Violence Policy COMPANY SPECIFIC ORIENTATION*Please check all items that were covered throughout your orientation: Select All Company Introduction Health and Safety Manual Assignment of Responsibility Hazard Assessment and Control Job Specific Formal Hazard Assessments Safe Work Practices Safe Job Procedures Personal Protective Equipment Preventative Maintenance Training and Competency General Company and Employment Rules Discipline Inspections Training & Communication Investigations and Reporting Emergency Response and Preparedness Legislation Obligation to Refuse Unsafe Work Drugs and Alcohol Communication Workplace Violence and Harassment Absenteeism and Accountability of Property Payroll including Hours/Overtime/Vacation/Time Off/Healthcare Benefits Availability INTRODUCTION AND TOURS*Please check all that apply with regards to your orientation: Select All Introduction to Department Staff & Key Personnel Tour of Facility/ Restrooms/ Lunchroom/Coffee Room Designated Smoking Area Parking Areas PPE Requirements in shop & yard Muster Point Fire Protection Emergency Exits First Aid Kits Eye Wash Stations Fire Extinguishers Consent* I understand that it is my responsibility to learn how to do my job safely and must refuse to do any work I feel is unsafe, including operating any tools, vehicles, or mobile powered equipment for which I am not trained and deemed competent for. I understand that by accepting employment with, and by working for Barrack Energy Services, I commit to fully and cooperatively participate in the Health and Safety Program. I acknowledge that I have been trained on all elements checked or initialed above, and commit to obey and follow the company policies, standards, practices and procedures.* REQUIRED DOCUMENTATIONYou may take this opportunity to upload any required documents necessary to complete your orientation. Please note, these may be brought into the office to copy/scan if you do not have access to them at this time. Some examples of what you can upload are listed below; First Aid Ticket *Required H2S Ticket *Required CSO Ticket *Required Resume 5 Year Commercial Drivers Abstract (if driving a Barrack owned vehicle). Other relevant safety tickets such as Ground Disturbance/AWP/Zoom Boom training REQUIRED DOCUMENTATIONYou may take this opportunity to upload any required documents necessary to complete your orientation. Please note, these may be brought into the office to copy/scan if you do not have access to them at this time. Some examples of what you can upload are listed below; First Aid Ticket *Required H2S Ticket *Required CSO Ticket *Required Resume Other relevant safety tickets such as Ground Disturbance/AWP/Zoom Boom training Commercial Liability Insurance - $5,000,000 (Barrack Energy Services needs to be added as an Additional Insured. Must have Waiver of Segregation included. Must provide Barrack with a 30 day notice of cancellation) Certificate of Incorporation WCB Clearance Commercial Vehicle Insurance & Registration 5 year Commercial Drivers Abstract should your position require driving a Barrack owned vehicle REQUIRED DOCUMENTATION Drop files here or Select files Max. file size: 100 MB. You also have the option to email documents/tickets to tickets@barrack.ca or text images to 780-897-1234 if necessary.
