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DOLT M (DRental <br />or Calirornia S 1 6 1 [ <br />Employee CaUOSHA, CaUEPA <br />Training Record <br />0380 <br />EMPLOYEE NAME: Last, First, MI. (Print) Employee tt Job Title <br />DIVISION I DEPARTMENT LOCATION <br />Required Training <br />References <br />Frequency <br />Training Date <br />Employee Signature Instructor <br />IIPP (InjurylIllness Prevention) <br />CCR Title 8, GISO 3203 <br />Initial 4� <br />1 1t 1 <br />L�L <br />C 11 <br />EmergencyAction Plan <br />CCR Title 8, GISO 3220 <br />Initial< (t, <br />� <br />Fire Prevention Plan <br />CCR Tide 8, GISO 3221 <br />' II <br />Initial(/�/ <br />� <br />Hazardous Communication <br />CCR Title 8, GISO 5194 <br />•Inibd <br />" / GI <br />Right to Know <br />CCR Tide 8, GISO 5194 <br />Initia4l6 t/ <br />1 U <br />C� <br />4% <br />Lockout-Tagout <br />CCR Tide 8, GISO 3314 <br />'Inid <br />a22J11 <br />Personal Protective Equipment <br />CCR Tide 8, GISO 3380 <br />'Initial QJ <br />fit <br />I <br />n <br />Hazardous Material M mt. <br />HSC Section 25500 <br />Initial 61/ <br />lY <br />' <br />uy <br />Spill Prevention/Control Plan <br />CRT Tide 40, Part 112 <br />Initial/. <br />l,// <br />�� �� <br />Hearin Conservation <br />CCR Tide 8, GISO 5097 <br />—Initi�W <br />7 <br />Respirator Protection <br />CCR Tide 8, GISO 5144 <br />—Initial <br />' <br />Fire Extinguisher <br />CCR Tide 8, GISO 5161 <br />"'Initis <br />_ <br />.� tt <br />Ergonomics <br />CCR Tide 8, GISO 5110 <br />7 <br />Hazardous Waste Management <br />CCR Tide 22, 66265 <br />.-1 Illiw <br />Lift Truck /\ <br />29 CFR 1910.178 <br />"'Initw. <br />0 <br />GG <br />r <br />Hoist/Cranes <br />CCR Title 8, GISO 4884 <br />Initial( <br />!1/ <br />Machine Guarding <br />CCR Tide 8, GISO 4243 <br />"'Inid W <br />Back Injury Prevention <br />CCR Tide 8, GISO 3203 <br />InifialC <br />W 17 <br />Fall Protection <br />CCR Tide 8, GISO <br />Blood Borne Patho ens <br />CCR Title 8, GISO 5193 <br />jlnitiaICQ--� <br />—Initial _ <br />Az <br />Code of Safe Practices <br />CCR Title 8, GISO 3203 <br />InifiaiL. <br />Sips, Trips, & Falls <br />CCR Tide 8, GISO 3203 <br />Inida <br />Blocking & Cribbing <br />CCR Tide 8, GISO 3203 <br />'Initial <br />(% <br />kk Other R <br />Smith System <br />CHP Driver Training <br />wolo9,� S�f�+ .0/05 , _ c . <br />NOTE: Retain this training form for duration employee is employed by Holt of California. <br />' Indicates additional training if new material/procedure is introduced to work area. Submit <br />" Indicates Initial training if department employee reports a repetitive motion injury. <br />— Indicates annual or refresher training required. <br />NOTE: Sy signing this form, employee states he/she has received training in subject matter. <br />vd–we snwu� <br />