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GENERAL SAFETY ORIENTATION CHECK/LIST <br /> NAME: M O RC/V o S G /u vl ! .S/VGYOS / <br /> (PRINT) LAST FIRST M) DATE-OF-HR1E <br /> COMPANY ASSIGNED: O / / TYPE OF WORK: 71LUC d.r, ✓C 1- <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE / COMMENTS: <br /> [IL <br /> COMPANY SAFETY POLICIES/PROGRAMS /V <br /> �P_eV toA eS LO$ MAp/UQLe-S <br /> ❑ SAFETY RULES,GENERAL AND JOB SPECIFIC /V O f Z L;d e A/-leS Nn L ACF y j yd VrAS <br /> ❑ SAFETY RULES ENFORECEMENF PROCEDURES F-VA r 1A(' O bl p p(' n Ad&- dr by yoS 1.r)42VAC'. <br /> ❑ WHEN,WHERE AND HOW TO REPORT INJURIES t--f///Form[ eL w, ssvlw d !J R lPo A L cl!`t PH L <br /> ❑ WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS I/�'1r�r cL °^fSMo d/A Al jjS;pA deli-YAl"o <br /> ❑ REVIEW OFFIREIEMERGENCYEVACUATION PLAN Rev,s>3n-•os /yjtdey-do -fer1a.NA1. MAPF <br /> ❑ LOCATION AND USE OF FIRE EXTINGUISHERS c'N co FI;oNef -n'1-at- OV},4,,p /91'�pI"A1OYiM'f` <br /> 1 _ d e,bL-rhdv <br /> ❑ SAFE WORK CLOTHING A(Q PAff4-AZO44:LE (Oi-4cr No ope.NShcoc_ <br /> ❑ HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. D C-b--N�h e L ePo r l e <br /> ❑ HAZARD COMMUNICATION PROGRAM: (Zq_.((!L /pp pScpm MG ns /N QYM pG'a e ✓ GS'�/L <br /> N �'L Skog <br /> MSDS,IIPP,HAZCOM SVIy'cNdo "/6aya*40 TegLA3 VSAmto Aps ntA)KRS a Vl gJv <br /> ! VS11VIAO <br /> ❑ SPECIFIC HAZARDS TO JOB ASSIGNMENTC�nfA(8Cp / LGN de Se V i7'j h <br /> ❑ ASSIGNMENTAJSE/CARE OF PERSONAL PROTECTIVE EQUIPMENTD06LAV- tA5 Rod LLgS SGKAAC SU-C✓er/JC <br /> ❑ PROPER LIFTING PROCEDURES(VIDEO) e L C A t oY P V c (a .AS-c p i e UA 0 0 <br /> ❑ HEAT STRESS AND HEAT STROKE PREVENTION SVdAk- SACA LCL <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: � S' ILLv� DATE• <br /> (SIGNATURE) y <br /> SUPERVISOR: DATE: Z 7 r/ <br /> IGNATU ) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />