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GENERAL SAFETY ORIENTATION CHECKLIST <br /> NAME: B r4 Vl UI A n 1 r r p 2 - 2 <br /> (Pw� w "I 1�DAT&OF-HIRE <br /> COMPANY ASSIGNED: 21f E TYPE OF WORK: D r 1 vs r <br /> THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD BY ME: <br /> ❑.,/ CHECK HERE C NTS'. �•// <br /> e0c: MPANY SAFETY POLICIES/PROGRAMS �/��aynQh � s - "G�d h/�3 <br /> ED <br /> �SAFETY RULES,GENERAL AND JOB SPECIFIC '"O J�} 'k f I e s - n o 'q <br /> B}'/SAFETY RULES ENFORECEMENT PROCEDURES 0. e U 1 C\.k) <br /> 1£ <br /> as WHEN,WHERE AND HOW TO REPORT INJURIES <S�m-k 0. A 1 S o f C f r 7 R <br /> 2(WHEN,WHERE AND HOW TO REPORT UNSAFE CONDITIONS J 0.Wl-4P_ 0`Y u ( S C, C 4 k r J1 " <br /> (d REVIEW OF FIRE/EMERGENCY EVACUATION PLAN �C��1,J f- <br /> .55 <br /> at/,MCATION <br /> �f�GreU� <br /> (a//DCATION AND USE OF FIRE EXTINGUISHERS 5 S S S /1 <br /> 02"SSAFE WORK CLOTHING O O r 5 ' Ste! oes <br /> I HOUSEKEEPING RULES,I.E.:SPILL CLEANUPS,ETC. CG("I o, / tie f I_e O f <br /> HAZARD COMMUNICATION PROGRAM: ( I f>1 <br /> MSDS,IIPP,IiAZCOM / i s D 5 _504 J )'C <br /> )/ el <br /> � 'SSPECIFIC HAZARDS TO JOB ASSIGNMENT I( b 1 N- 'O <br /> Ly <br /> ASSIGNMENTNSE/CARE OF PERSONAL PROTECTIVE EQUIPMENT` / SS <br /> PROPER LIFTING PROCEDURES(VIDEO) /3a� k a- + i w -,q,, l <br /> ?EMPLOYEE,CERTIFIED IN FOLLOWING I.E.:CPR,ETC. L 0.S S 7X M J- F rk //f I <br /> XADDITIONAL TRAINING REQUIRED: s ii f e Q e r I g Ol 11 c- <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: DATE: <br /> (SIGNATU <br /> SUPERVISOR: DATE: <br /> IG ATURE) <br /> N:\Safety\GENERAL SAFETY ORIENTATION CHECKLIST.doc <br />