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GENERAL /SAFETY ORIENTATION CHECKLIST <br /> NAME: <br /> (PRINT) LAST FIRST MI DATE-OF-HIRE <br /> i <br /> COMPANY ASSIGNED: t� L TYPE OF WORK: Dr, 'I , ,- <br /> THE <br /> TTHEE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> I���,,'// CHECK HERE COMMENTS: <br /> 42-'COMPANY SAFETY POLICIESIPROGRAMS <br /> Et-SAFETY RULES,GENERAL AND JOB SPECIFIC O L i• JrP�, 7. <br /> 2-SAFETY RULES ENFORECEMENT PROCEDURES ? <br /> ©TVHEN,WHERE AND HOW TO REPORT INJURIES ,� w{G <br /> WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS <br /> 12 <br /> REVIEW OF FIRE/EMERGENCY EVACUATION PLAN <br /> D—LOCATION AND USE OF FIRE EXTINGUISHERS S <br /> ���� <br /> CI SAFE WORK CLOTHING /�, <br /> f3 HOUSEKEEPING RULES,LE.:SPILL CLEANUPS,ETC. 1�r yq� <br /> B4'�ARD COMMUNICATION PROGRAM: 'I AS F 3 1 (�a-2T� <br /> ��,, MSDS,IIPP,HAZCOM <br /> Jd <br /> �OEESD�IFIC HAZARDS TO JOB ASSIGNMENT - �n <br /> D AAS/SSIGNMENTIUSFJCARE OF PERSONAL PROTECTIVE EQUIPMENT lF r$ �SIL �/C/.1�� <br /> 940PER LIFTING PROCEDURES(VIDEO) {�S - t�Ll- ftil- Yk. ,IIklk-1 / fa <br /> ❑ HEAT STRESS AND HEAT STROKE PREVENTION ,Q � ,i�1 �6 Y�J%Y-! +fS dt— 1---, " <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 Y QU I IVSNSWERED TO MY SATISFACTION: <br /> EMPLOYEE DATE: <br /> (SIGNATURE) � <br /> SUPERVISOR: d� %L�/�/U/l/Gt �if;IP�J DATE: S, <br /> (SIGNATURE) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />