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�� vu )n m 5jon <br /> GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: r i _ <br /> (PRINT) LAT FIRST MI I D4TE-OF-HIRE <br /> COMPANY ASSIGNED: TYPE OF WORK: <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE I COMMENT / <br /> [I COMPANY SAFETY POLICIESIPROGRAMS // O /G'IIO�JCS' <br /> ❑ SAFETY RULES,GENERAL AND JOB SPECIFIC oa / / G dCNG[S <br /> ❑ SAFETY RULES ENFORECEMENT PROCEDURES �tr�asjonay IldfiQ ���bs Yt/AtjgGs�ny <br /> ❑ WHEN,WHERE AND HOW TO REPORT INJURIES *?&mL Par� ./ , <br /> [I WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS / otxV d4✓ <br /> ❑ REVIEW OF FIREIEMERGENCY EVACUATION PLAN <br /> ❑ LOCATION AND USE OF FIRE EXTINGUISHERS / / 1 Pees <br /> ❑ SAFE WORK CLOTHING /IO eala s ry6�Q <br /> ❑ HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. <br /> ❑ HAZARD COMMUNICATION PROGRAM: fu, � In� 16 4 gko, <br /> MSDS,UPP,HAZCOM I ra/ Cr+Mip7, <br /> ElSPECIFIC HAZARDS TO JOB ASSIGNMENT C <br /> ❑ ASSIGNMENTIUSEICARE OF PERSONAL PROTECTIVE EQUIPMENT—/r PI F e m Y��I ; <br /> ❑ PROPER LIFTING PROCEDURES(VIDEO) � VUU!1/ /Qt /Y)0l� S s¢fCas g t C M-i. <br /> ❑ HEAT STRESS AND HEAT STROKE PREVENTION 70—mar Int"t / qCo( sg <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: r l CP!MO J r Z pp1 DATE: <br /> (SIGNATURE) <br /> SUPERVISOR: DATE: 7- 22 - 11 <br /> (SIGN RE) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />