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c4 (;C <br /> GENERAL SAFETR' ORIENTATION CHECKLIST <br /> NAME: S&,I'\ Aez JULGR M _ 3 - ► 5 - a Oil <br /> (PRINV LAST FIRST C M/ DATE-OF-HIRE <br /> A <br /> COMPANY ASSIGNED. I I f C TYPE OF WORK: rock J r Iy e r <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE COMMENTS: <br /> 0 COMPANY SAFETY POLICIES/PROGRAMS R ecJ 01 <br /> 12f SAFETY RULES,GENERAL AND JOB SPECIFIC _RR �C— A _ 5I3 SAFETY RULES ENFORECEMENT PROCEDURES S a Vel w - Bo n U S y— Term <br /> m WHEN,WHERE AND HOW TO REPORT INJURIES S A hS e d 4 V — DIS 2A 1 c V e r <br /> 0 WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS S&Me dcy _! (O D ;S 4 f CL/�e'1r.—C�_ <br /> 12•REVIEW OF FIREIEMERGENCY EVACUATION PLAN K e V 1 e W J I C }( I OTO ANC <br /> D 0 <br /> t9 LOCATION AND USE OF FIRE EXTINGUISHERS R e view 11 Pa S S 51 s t e n <br /> IS SAFE WORK CLOTHING R S�OrI $ . Ro 0r,A tae 51,ees_ <br /> [�] HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. C on feki A 1616 Re Pcri <br /> ($HAZARD COMMUNICATION PROGRAM: ISot c I I find )ARzcon <br /> MSDS,IIPP,HAZCOM M SDS a A 4 S J-e k y O F r( e S. <br /> SPECIFIC HAZARDS TO JOB ASSIGNMENT !Mini Al an fy01 VAeAt 8 Falk1 IFf <br /> 64 ASSIGNMENT/USE/CARE OF PERSONAL PROTECTIVE EQUIPMENT(110,5 VLe 5 1 1/ �4td I Gc I £u T- <br /> U 4 S <br /> PROPER LIFTING PROCEDURES(VIDEO) 1.)o,C�� a l fT 1� e,` LU h 6 c L - L O <br /> EMPLOYEE.CERTIFIED IN FOLLOWING I.E.:CPR,ETC. <br /> ( ADDITIONAL TRAINING REQUIRED: <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,1 HAVE BEEN ABLE TO ASK <br /> QUESTIONS AND HAVE MY QUESTIONS ANSWERED TO MY SATISFACTION: <br /> EMPLOYEE: i DATE: J - I S — ,;1611 <br /> (SIGN ARE) <br /> SUPERVISOR: DATE: 7 (( <br /> �r (S p <br /> NATURE) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />