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GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: S ( /u G+/ P6 u1I N'p'cR - —) - ,D- 0 1 ( <br /> (PRINT) LAST FIRST M/ DATE-OF-HIRE <br /> COMPANY ASSIGNED: '07XTO)V/IV I TYPE OF WORK: ➢� �/ �� <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE COMMENTS: <br /> LtYCOMPANY SAFETY POLICIES/PROGRAMS <br /> �Vl� <br /> 'SAFETY RULES,GENERAL AND JOB SPECIFIC N c T7 Z, A)O h{j SL <br /> (77,, SAFETY RULES ENFORECEMENT PROCEDURES <br /> HYn wHEN,WHERE AND HOW TO REPORT INJURIES / 'Z <br /> I k I� <br /> 2-WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS 17E,e C-k Ii V R <br /> [PREVIEW OF FIRE/EMERGENCY EVACUATION PLAN <br /> [J LOCATION AND USE OF FIRE EXTINGUISHERS S <br /> L,[yvSAFE WORK CLOTHING <br /> LK HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. may, <br /> [A'9AZARD COMMUNICATION PROGRAM: <br /> MSDS,IIPP,HAZCOM NS . ) /Y '--5'/`�P <br /> SPECIFIC HAZARDS TO JOB ASSIGNMENT �3 P• p -�Fo 2 <br /> ED-ASSIGNMENT/USE/CARE OF PERSONAL PROTECTIVE EQUIPMENT / c!- � A/ <br /> Y <br /> [!r PROPER LIFTING PROCEDURES(VIDEO) 1�n d7-?,-7-jry- <br /> 0y HEAT STRESS AND HEAT STROKE PREVENTION <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: �Q uq tide S F� DATE: -7 <br /> (SIGNATURE) <br /> SUPERVISOR: DATE: <br /> (SIGNATURE) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc Updated 1/2011 <br />