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GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: 090" DMIUOy a ?-5- "1' <br /> (PRINT) LAST FIRST A, G M/ DATE-OF-HIRE <br /> COMPANY ASSIGNED: TYPE OF WORK: -T�vAyc/ <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑,/ CHECK HERE y�� COMMENTS: <br /> e COMPANY SAFETY POLICIES/PROGRAMS yT�c9 }A"oyyrL 7 - MPc1.l.�A(-,> <br /> 121/SAFETY RULES,GENERAL AND JOB SPECIFIC , NO //KI UA-IGS -NO /IPL 06 �,� / <br /> 0/SAFETY RULES ENFORECEMENT PROCEDURES �� 1�1()S --y'eyL(-w --lip- Ain <br /> M)/WHEN,WHERE AND HOW TO REPORT INJURIES �Jb�4 ')7A+�,,J� �s'PA9_4 <br /> [ WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS ���(% T�' 1 D LCj'Q?A' �Fkt -h v 1 v' <br /> (9 EVIEW OF FIRE/EMERGENCY EVACUATION PLAN J'�/rJ`Mpj�� �4;,N- J�(]AY <br /> ( LOCATION AND USE OF FIRE EXTINGUISHERS CK 194r� "�/>FyJ <br /> (-/�AFE WORK CLOTHING No CJ.'Abyac- I,tC) (5�� I-CE <br /> [Ij{H USGKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. <br /> HAZARD COMMUNICATION PROGRAM: <br /> �//MSDS,IIPP,HAZCOM ����pp,,``y� j� <br /> L/1SPECIFIC HAZARDS TO JOB ASSIGNMENT �rr//ro' SDS Cj Q(�.( <br /> V//ASSIGNMENTNSE/CARE OF PERSONAL PROTECTIVE EQUIPMENT T'I" <br /> I P OPER LIFTING PROCEDURES(VIDEO) <br /> Ir PLOYEF.CERTIFIED IN FOLLOWING I.E.:CPR,ETC. [l (�'n{(' �.�� f i n4c ni {_ "✓-�' � f; <br /> ADDITIONN.TRAINING REQUIRED: �, tl(� � n �©rte 6_ — 1 Y <br /> IMPORTANT: IF THIS EMPLOYEE IS TRANSFERRED TO ANOTHER JOB ASSIGNMENT, IT IS MANDATORY THAT 1V(/ <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 Y QUESSTIONS ANSWERED TO MY SATISFACTION: <br /> EMPLOYEE: � /l(/ j/ IAV X� DATE: 'Z-)" <br /> �I <br /> (SIGNATURE) q <br /> SUPERVISOR: DATE: <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />