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GENERALSAFETY ORIENTATION CHECKLIST <br /> NAME: GIA>0 r/ 1'5a"f?O 0, 07��2 Z OlO <br /> (PRINT) L4ST FIRST MI DATE-0FHIRE <br /> COMPANY ASSIGNED: TYPE TYPE OF WORK: <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> CHECK HERE _/ COMMENTS: <br /> v COMPANY SAFETY POLICIES/PROGRAMS (�-�`� FrG.2I4 S Q (jjCr/Y/G <br /> ��14AFETY RULES,GENERAL AND JOB SPECIFIC /c '✓� Udci S Q�Lra(B Cir/cc S <br /> �TY RULES ENFORECEMENT PROCEDURES rS�1 u�/'✓r/C.S Y/ �PLICG rIu$ <br /> EN.WHERE AND HOW TO REPORT INJURIESZ-HE /,G ./n 5 y/G h T •ss <br /> N,WHERE AND HOW TO REPORT UNSAFE CONDITIONS /(- o> ''-/ 4 <br /> �EVIEW OF FIRE/EMERGENCY EVACUATION PLAN �7� � <br /> /—C/-- <br /> ! L ATION AND USE OF FIRE EXTINGUISHERS L,G�h o car`//o S l LL�S <br /> E WORK CLOTHING AL- G G u4 /d Q� <br /> HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. <br /> �iAZARD COMMUNICATION PROGRAM: �jLhG�lvS <br /> MSDS,IIPP,HAZCOM ,S/y'yCls��/�0�,5 r'nG`. � yp faS <br /> Ja SPECIFIC HAZARDS TO JOB ASSIGNMENT 6156// /`-'"o cL a �e (.I I^O <br /> V�d�AS SIGNMENT/USF/CARE OF PERSONAL PROTECTIVE EQUIPMENT_C AM/e GOl `� k S/ G G <br /> L PROPER LIFTING PROCEDURES(VIDEO) GC$GI R- 65 of e-'rna�S C°v+' o 5D,- k <br /> (/EMPLOYEE CERTIFIED IN FOLLOWING I.E.:CPR,ETC. (S'+ Zs s Alec BSG r"6;740' �q� � <br /> 12/ADDITIONAL TRAINING REQUIRED: V/�pj ��•� �,$' /OLt C._J PT2 Ey rZt y�.e <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 ITE AVE BEEN ISCUSSED WITH ME,I HAVE BEEN ABLE TO ASK <br /> QUESTIONS AND VE MY U IONS ANSWERED TO MY SATISFACTION: <br /> EMPLOYEE: DATE: 07—/2 - -10/0 <br /> (SIGNATURE) <br /> SUPERVISOR: DATE: 7/2' /d <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />