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Vd-51on <br /> GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: ✓ i4f"_ 1 5-_" 14 L'` S 3 JFLt c( 3 � 7. -`-- <br /> (PRINT) LAST FIRST MI DATE-OF-HIRE <br /> COMPANY ASSIGNED: O S Y-° TYPE OF WORK: / �+C (✓ yT� <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑ CHECK HERE // COMMENTS: <br /> COMPANY SAFETY POLICIES/PROGRAMS Lf 4� iQB'-) Z j Pf /[S <br /> SAFETY RULES,GENERAL AND JOB SPECIFIC {y(1L_d GG i Liti�I�-3. A.a �a f�i.'^'G'0�(i✓�'1s <br /> SAFETY RULES ENFORECEMENT PROCEDURES T t-'�'�""ZS ", <br /> WHEN,WHERE AND HOW TO REPORT INJURIES ,yT. ` P4.,wtn 46�'7� ✓/l¢ppv T<- A �s� °� <br /> WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS Z He 5 M• 'A 'PA / 0 <br /> REVIEW OF FIREIEMERGENCY EVACUATION PLAN /f4 VI,`�C',4�r OQ-}-''/�'o je$t10 <br /> LOCATION AND AND USE OF FIRE EXTINGUISHERS �.t/ CQ. KGON c'vo vl DI��J1�-✓orf�Pr�/ �' B <br /> SAFE WORK CLOTHING NO -7 0 5 Rio ,,,,lj, Cd n7ta9 <br /> Q� HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. Ppd euaae <br /> HAZARD COMMUNICATION PROGRAM: <br /> MSDS,IIPP,HAZCOM ,v( S d S_ l �o µl9 ccs s f,.�.( 4 h, <br /> Q� SPECIFIC HAZARDS TO JOB ASSIGNMENT <br /> ASSIGNMENT/USF/CARE OF PERSONAL PROTECTIVE EQUIPMENTGl1 a f&V ( P e S /U� <br /> [if PROPER LIFTING PROCEDURES(VIDEO) p0y �' 64,d#S CfL-CC dG St, c"PID <br /> HEAT STRESS AND HEAT STROKE PREVENTION A,414yc1k4 .q-iris4 r�Kc^ YVev AS-W4 Coral,*4114�05 <br /> X PL- /3" cE Ic Sc P'w4 3 <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 AVE MY QUESTIO A SW�E ED TO MY SATISFACTION: <br /> EMPLOYEE L ' '^�/�--- �' DATE: <br /> /// (SIGNATURE) <br /> SUPERVISOR: DATE: <br /> IGNA RG) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />