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GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: gV-if � G/r x2 �/ <br /> (PRINT) �� F T MI DATE-OF-HIRE <br /> COMPANY ASSIGNED: ,�E TYPE OF WORK: J�-i I/G� <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE COMMENTS: <br /> ❑ COMPANY SAFETY POLICIES/PROGRAMS t'le�c�- ". A n <br /> ❑ SAFETY RULES,GENERAL AND JOB SPEC1171C N�j e Sj C \mak c� <br /> ❑ SAFETY RULES ENFORECEMENT PROCEDURES <br /> Cl WHEN,WHERE AND HOW TO REPORT INJURIES <br /> ❑ WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS <br /> ❑ REVIEW OF FIRE/EMERGENCY EVACUATION PLAN .�ekfiL s./ Nn,t, dPG �frrk�/' n ��/y 6-rc UC <br /> ❑ LOCATION AND USE OF FIRE EXTINGUISHERS <br /> ❑ SAFE WORK CLOTHING <br /> Cl HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. <br /> ❑ HAZARD COMMUNICATION PROGRAM: <br /> MSDS,IIPP,HAZCOM 1�41.s <br /> ❑ SPECIFIC HAZARDS TO JOB ASSIGNMEN"f <br /> ❑ ASSIGNMENT/USE/CARE OF PERSONAL PROTECTIVE EQUIPMENT SSS L) �$( SLLg1aS tf f'd HST <br /> ❑ PROPER LIFTING PROCEDURES(VIDEO) j ¢ ( <br /> ❑ HEAT STRESS AND HEAT STROKE PREVENTION '20 \x�- V; <br /> T <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 AVE MY QUESTIONS ANSWERED TO MY SATISFACTION: <br /> EMPLOYEE: DATE: ,j�;— <br /> (SIGNATURE) <br /> SUPERVISOR: DATE: <br /> T ) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />