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GENERAL S <br /> AFETY ORIENTATION CHECKLIST <br /> NAME: Coy(220 <br /> (?R/NTJ LAST F/RS! MI <br /> A <br /> DATE-OF-HIRE <br /> A <br /> COMPANY ASSIGNED: _ F F TYPE OF WORK- <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE <br /> COMMENTS: <br /> ❑ COMPANY SAFETY POLICIES/PROGRAMS ICC Y fi7d)5 425 <br /> mon v J/ '0J< <br /> ❑ SAFETY RULES,GENERAL AND JOB SPECIFIC AQ al e n .r 6 ft Sfi,�.o )V �L) <br /> ❑ SAFETY RULES ENFORECEMENT PROCEDURES eba./�.fRC Ion ��YzlyT..�y .je0l/n 1,1TQ <br /> ❑ WHEN,WHERE AND HOW TO REPORT INJURIESI)lkrinar i2l n+llrno dlu Q� d,3/chador <br /> ❑ WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS 10�2 t y0a d tol yn 151'1')0 J <L al 1p51ac h ad q <br /> ❑ REVIEW OF FIRE/EMERGENCY EVACUATION PLAN p A: S35 <br /> ❑ LOCATION AND USE OF FIRE EXTINGUISHERS wo t P N - Z'_-Y epor to Y <br /> ❑ SAFE WORK CLOTHING n0 sHi-a S <br /> ❑ HOUSEKEEPING RULES,1.E.:SPILL CLEANUPS,FTC. <br /> ❑ HAZARD COMMUNICATION PROGRAM: /C�jr - e /� I�n /L /•G�„/:Q/MQ <br /> MSDS,IIPP,FIAZCOM <br /> ❑ SPECIFIC HAZARDS TOJOB ASSIGNMENT 5uICndO V hQ2odO f#-L�(,da-1 <br /> ❑ ASSIGNMENT/USE/CARE OF PERSONAL PROTECTIVE EQUIPMENT/en t P'S dc' S e UVYI da y) I. c hp l e( o <br /> ❑ PROPER LIFTING PROCEDURES(VIDEO) <br /> ❑ HEAT STRESS AND HEAT STROKE PREVENTION ✓�(�Y rnuch cC7Q, uGly ,¢c�fj�r�� v� <br /> /J--) e05-�?-5 2 el blc� 7e <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: '7t)V V) � AL2 2 O DATE: <br /> n (SIGNATUR <br /> SUPERVISOR: { JI1 L f(,IAS I �Jfff Y Y DATE: <br /> U (SIGNATURE) <br /> N:\Safety\GENERAI. SAFETY ORIENTATION CHECKLIST.doc <br />