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Employee Cal/OSHA, CalfEPA <br />Training Record <br />EMPLOYEE NAME: Last, First, NII. (Print) Empl- # Job Title Qd p_ 1� , <br />DIVISION/DEPARTMENT LOCATION <br />Required Training <br />References Frequency Date Trng. Employee Sign. Instructor <br />IIPP (Injury/Illness Prev. <br />CCR Title 8, GISO 3203 Initial <br />Emergency Action Plan <br />GISO 3220 Initial <br />Fire Prevention Plan <br />GISO 3221 Initial <br />Hazardous Comm. <br />GISO 5194 *Initial <br />Lockout Tagout <br />.' GISO 3314 *Initial - — <br />Personal Protective Eq. <br />GISO 3380 *Initial <br />OSHA Right to Know <br />Cal/OSHA Initial <br />Haz. Material MnmgL <br />HSC section25500 Initial <br />Spill PrevJControi Plan <br />CFR Title 40, Part 112 Initial <br />Hearing Conservation <br />CCR Title 8, GISO 5097 Initial/annual <br />Respirator Protection <br />GISO 5144 Initiallannual <br />Fire Extinguisher <br />GISO 5161 Initiallannuai <br />Ergonomics <br />Haz. Waste Mnmgt <br />GISO 5110 ** <br />CCR Title 22, 66265 Initial/annual L -- ZIP 5- <br />Lift Truck <br />29 CFR 1910.178 Initial/annual <br />Hoist/Cranes <br />GISO 4884 Initial <br />Other req. Training: <br />Smith Systems <br />Initial <br />CHP Driver Training <br />Initial <br />NOTE: Retain this training form for duration employee is employed by HOLT of California <br />* indicates additional training if new material/proceedure is introduced to work area <br />** indicates initial training if departrnent employee reports a repetative motion injury <br />FORM SA0001 <br />