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ON-SITE TRAINING FORM <br /> ANNUAL REFRESHER TRAINING VERIFICATION <br /> Name of Company: <br /> Street Address: <br /> City, Zip Code: <br /> Employee Name (Print) <br /> I acknowledge that I have received and understand environmental compliance training in <br /> the following areas (please initial or mark N/A for not applicable): <br /> Initial Date <br /> Hazardous Materials Management Hazardous Materials Management/Business Plan <br /> 1. Which materials at the facility are hazardous <br /> 2. Where these materials are stored <br /> 3. How these materials are to be handled, stored, and disposed of <br /> 4. What Material Safety Data Sheets MSDS are and where they are kept at the facility <br /> 5. Training topics included in the HMMP, including review of MSDS and the emergency <br /> response plan <br /> Spill and Leak Response (Spill Response Plan) <br /> 1. Location of spill response equipment <br /> 2. Location of spill or leak contact list, reporting procedures <br /> 3. Location of emergency fuel shut-off switch <br /> Employee Signature Social Sec. Number Date <br /> Training verified by <br /> Instructor Date <br /> MAINTAIN THIS FORNI THE ENTIRE TLNIE THE EMPLOYEE WORKS AT THE FACILITY <br />