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GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: S)NC. SHT4INDEz Rlaa) n <br /> (PRINT) LAST FIRST M/ ATE- F-H/RE <br /> COMPANY ASSIGNED: AMTO"'wii FREIGHT TYPE OF WORK: -TRUCJc DRIVC2 <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE COMMENTS: <br /> ❑ COMPANY SAFETY POLICIES/PROGRAMS RfFlD AGL MANUALS <br /> ❑ SAFETY RULES,GENERAL AND JOB SPECIFIC A/0 AC60GVTS I hlo IN3U,06S <br /> SAFETY RULES ENFORECEMENT PROCEDURES ^ / -/ <br /> ❑ PE/ZFO�MANL� PY L,iF3 (J//�JA�US /N�J�iA•gT��y� <br /> ❑ WHEN,WHERE AND HOW TO REPORT INJURIES SAME DAV nii OATCNElz <br /> ❑ WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS SAM a DAV niS PAYCNER <br /> [I REVIEW OF FIRE/EMERGENCY EVACUATION PLAN REVUE ' SyoGIToN "P <br /> SWpEEL / <br /> ❑ LOCATION AND USE OF FIRE EXTINGUISHERS IN Cie -, pp 1 L AIM; S 6710Vlw c <br /> ❑ SAFE WORK CLOTHING pe 0 ir+I -7oFo jf&ArS_ /Ya SNgeTS <br /> ❑ HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. 0DWrAM ANP oWPoRT <br /> ❑ HAZARD COMMUNICATION PROGRAM: RECj I UF_2`Q, NAZ-CaM <br /> MSDS,IIPP,HAZCOM . PISDS 1mrotown-)l /S //Y THF SHOP <br /> ❑ SPECIFIC HAZARDS TO JOB ASSIGNMENT uJoAlfiNq HR > Z+ak Iicf J G7w.+ {JAnnJ$wkcv <br /> ClMQUIC "t <br /> ASSIGNMENTNSEICARE OF PERSONAL PROTECTIVE EQUIPMENT V EST Anill GLASSES 0,-C r nvc sKK< <br /> ❑ PROPER LIFTING PROCEDURES(VIDEO) opo yoVR knIECS CLOSE 7 THC go y <br /> ❑ HEAT STRESS AND HEAT STROKE PREVENTION Vkwk Lo-0 Co-1- 1.JATECy 6v4YcN C. Wa[KE/,(' Fw2 SC uS <br /> IMPORTANT.- IF THIS EMPLOYEE IS TRANSFERRED TO ANOTHER JOB ASSIGNMENT,IT IS MANDATORY THAT <br /> A NEW SAFETY ORIENTATION CHECKLIST FORM IS FILLED OUT. <br /> THE ABOVE ITEMS HAVE BEEN DISCUSSED WITH ME, I HAVE BEEN ABLE TO ASK <br /> QUESTIONS AND HAVE MY QUESTIONS ANSWERED TO MY SATISFACTION: <br /> EMPLOYEE: DATE: 9 id) / <br /> (SIGNATURE) pJ <br /> SUPERVISOR: ! / DATE: Z <br /> IGNATURE <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />