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GENERAL SAFETY/ORIENTATION CHECKLIST <br /> NAME: / LV NA �i l�V 4//' <br /> (PRINT) ST FIRST I f M/ 7 DATE-OF-HIRE <br /> COMPANY ASSIGNED- ALF TYPE OF WORK: 1� r Ve Y <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE COMMENTS: <br /> ❑ COMPANY SAFETY POLICIES/PROGRAMS Y' 4 C.j <br /> ❑ SAFETY RULES,GENERAL AND JOB SPECIFIC C(C dg" <br /> ❑ SAFETY RULES ENFORECEMENT PROCEDURES <br /> ❑ WHEN,WHERE AND HOW TO REPORT INJURIES /� �i,Nn ,P P,.L/ ,1 p c cj C l <br /> ❑ WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS og i a 4 ;/r ;rps/� I <br /> ❑ REVIEW OF FIREIEMERGENCY EVACUATION PLAN SS <br /> ❑ LOCATION AND USE OF FIRE EXTINGUISHERS <br /> ❑ SAFE WORK CLOTHING no c;;h&kk on 19�s§k <br /> ❑ HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. D <br /> ❑ HAZARD COMMUNICATION PROGRAM: /Q <br /> MSDS,IIPP,HAZCOM ' <br /> ❑ SPECIFIC HAZARDS TO JOB ASSIGNMENT C larm -- <br /> r1- <br /> 0 ASSIGNMENT/USE/CARE OF PERSONAL PROTECTIVE EQUIPMENT 1!5�lP S a . 1-Y en ✓ �©tk <br /> ❑ PROPER LIFTING PROCEDURES(VIDEO) 6 I . <br /> ❑ HEAT STRESS AND HEATSTROKE PREVENTION 1 �II gdyp-jrs LJrr l� <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 AIWWERED TO MY SATISFACTION: <br /> EMPLOYEE: I All DATE: `-1 <br /> SIGNA T <br /> SUPERVISOR: �' DATE: <br /> (SIGNATURE) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />