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GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: SJN I Vti Ar{ V� - 2 /-// - / C7 <br /> (PRIM) IAST F7XV7'' M/ DATE'-OF'-HIR <br /> AE-' <br /> COMPANY ASSIGNED: r 'e TYPE OF WORK: Llt/-' V t <br /> THE FOLLOWING ITEMS HAVE. BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> 0 CIIECK IIF.RE COMMIENTS: <br /> Z COMPANY SAFETY POLICIES/PROGRAMS Ip ztiJG// � V i If <br /> PrSAFETY RULES,GENERAL AND JOB SPECIFIC 44 C fC <br /> WSAFLTY RULES F.NFORFCEMEN'1'PROCEDURES A IO <br /> ,r7 <br /> WHEN,WHERE;AND HOW I'D REPORT INIURII S mpp�- C � V•4ASIc% <br /> WHEN,WHERE AND HOWL'O'REPOR'I'UNSAFE('ONDITIONS <br /> .REVIEW OF FIRE/EMERGENCY EVACUA"PION PIAN _ S '�'���+•� jE/l (T/roN� • -� / <br /> 01.00ATION AND USF:OF FIRE EXTINGUISIIERS r�v' <br /> gSAi'I:WORK CI.O'1'iI1N0 !✓J _s/. C �L> Q/ '�'�✓!-�5'�ors <br /> og <br /> I <br /> ;3-<OUSEKEEPING RULES, I.E.:SPILT.CLFANUPS,F I'C. Lure n1 iU� _,c <br /> IA 1A/'.ARD COMMUNICA'T'ION PROGRAM: --sem <br /> . SDS,IIPP,HA/_COM <br /> SPECIFIC fW..ARDS I'O JOE ASSIGNMENT - <br /> ASSIGNMENMUSE/CARE OP PERSONAL PRO'1'IiCI'IVE L'QUIPMEN I'�4 r1 ' `'/+i <br /> ,O PROPERLIITINGPROCEDURES(VIDF:O) f)t✓`1"r' V �l�tJ <br /> JOBMPLOYEIi CERTIFIED IN FOLLOWING T.E.:CPR,ETC. �f((/� / p <br /> j('fADUI'1'IONAL TRAINING REQUIRED: �l h 11 .�� <br /> IMPORTANT.IT:'FI IIS EMPLOYEE IS TRANSFERRED TO ANOTHER IDE ASSIGNMI:NI',ITIS MANDATORY THAI' <br /> A NEW SAFE,TY ORTENTA""TION CHECKLIST FORM IS FILLED OUT. <br /> THE ABOVE ITEMS HAVE, BEEN DISCUSSED WITH ME, I HAVE BEEN ABLE TO ASK <br /> QUESTIONS AND HAVES MY QUESTIONS ANSWERED TO MY SATISFACTION: <br /> EMPLOYEE: 42Z C Z-� !�: DATE: <br /> (SIGNATURE) <br /> SUPERVISOR:� DATE: D/`11 <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc . <br />