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GENERAL SAFETY ORIENTATION CH/ECKLIST <br /> NAME: ACL) I//V&Z �� (-� &Z10 <br /> (PRINT) LIST FIRST MJATE F-HIR�E/ <br /> COMPANY ASSIGNED: 11446d// - TYPE OF WORK: 7'YLJe Jt tl y/ lied <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE COMMENTS: ,t, <br /> LYCOMPANY SAFETY POLICIES/PROGRAMS ENGi✓�7' Z"5 4-'.�'C'xo—Q J <br /> L'i S�AFETY RULES,GENERAL AND JOB SPECIFIC 71a ,6a7,2- , e oo4l Seo U r�rl o �1� <br /> ['SAFETY RULES ENFORECEMENT PROCEDURES �.✓ Ndcv los Av/sur CN ISS IVe Aa'v'n <br /> OMEN,WHERE AND HOW TO REPORT INJURIES Repoi czy �i7o�m <br /> LY /viiwlli✓ ewfc-.r/�(�\ <br /> 0-WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS CpD�K7�' o/ dd o ucHot!�S Sao,tJ Yi <br /> /REVIEW OF FIRFIEMERGENCY EVACUATION PLAN eJYQCJ� G/AJ G?V�Q.S 2P F,dCxr C/spy. <br /> [���[.00ATION AND USE OF FIRE EXTINGUISHERS �Q�jr�y Cua vdv Te <br /> LST SAFE WORK CLOTHING V-s AY O <br /> �/�H/OUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. Ra y� /a,�41J / Q. L'Yiq 1 q�re sea-> <br /> �J HAZARD COMMUNICATION PROGRAM: �)) <br /> MSDS,IIPP,HAZCOM <br /> m/SPECIFIC HAZARDS TO JOB ASSIGNMENT <br /> 7I$ SIGNMENT/USF/CARE OF PERSONAL PROTECTIVE EQUIPMENT <br /> �PROPER LIFTING PROCEDURES(VIDEO) <br /> 'EMPLOYEE CERTIFIED IN FOLLOWING I.E.:CPR,ETC. OY�✓C/� C3,7//J/G <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,I HAVE BEEN ABLE TO ASK <br /> QUESTIONS AND HAVE MY QUESTIONS ANSWERED TO MY SATISFACTION: <br /> EMPLOYEE:F DATE: ( / <br /> (SIGNATU /�f <br /> SUPERVISOR: DATE: ( / <br /> I ATURE) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc i' <br />