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GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: (,JIB r'ccuQ &' u) -7 . 4 • t0 <br /> (PRINT) LAST FIRST A41 DATE-OF-HIRE <br /> COMPANY ASSIGNED: A F-Z TYPE OF WORK: <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> Eff/ CHECK HERE COMMENTS: <br /> EJCOMPANY <br /> COMPANY SAFETY POLICIES/PROGRAMS /<reAd All �1;u(o14 lAT10U <br /> Ly SAFETY RULES,GENERAL AND JOB SPECIFIC WOgK} <br /> sr/sAFETY RULES ENFORECEMENT PROCEDURES nn�Vo R Idr,&S <br /> 19WHEN,WHERE AND HOW TO REPORT INJURIES f,rc peAA SIAk f.,OA4 fi0 OLtA� <br /> (;VWHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS V-V- 01. <br /> C REVIEW OF FIREIEMERGENCY EVACUATION PLAN it u,gtd 54oc.klu(u.4•0K,.G%&r,,�It p- <br /> N_J/LOCATION AND USE OF FIRE EXTINGUISHERS Rrcp l/G.W YAS` f-[rCl+� <br /> lySAFE WORK CLOTHING (IA6 sF,N1A,4+ /40pT� GA TA TLPf <br /> (9/HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. <br /> ly <br /> HAZARD COMMUNICATION PROGRAM: �'- /F/ <br /> MATERIAL SAFETY DATA SHEETS(MSDS) f IT l�� l C/c� <br /> Gr <br /> HAZARDS TO JOB ASSIGNMENT �f�UUE.w ZPP�' t�A2MR(T� !/Aster <br /> G ASSIGNMENT/USE/CARE OF PERSONAL PROTECTIVE EQUIPMENT G_/MIAq O/j ARpIq i� ��'4s,VIST <br /> &/ <br /> —Tr- Got PI.ew <br /> (�J PROPER LIFTING PROCEDURES(INCLUDE DEMONSTRATION _ Rk ui!ll) C)L 40 <br /> EY/EMPLA)YEE CERTIFIED IN FOLLOWING I.E.:CPR,ETC. G A A T-IR(ADDITIONAL TRAINING REQUIRED: -T ij C.cdCC <br /> IMPORT4IVT.•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 WITH MY UNDERSTANDING: <br /> EMPLOYEE: ZZeA:2ja--h DATE: 7O <br /> (SIGNATURE) °T— <br /> SUPERVISO . DATE: D 7 <br /> SIGNATURE) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />