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HOLT M of caeroemis T' Employee Cal/OSHA, Cal/EPA Training Record U EMPLOYEE NAME: Last, First, MI. (Print) Employee # DIVISION / DEPARTMENT 04 t(. l'. ck �'t ( L Job Title LOCATION Ral G rnr� �'�CAMtL : _Cb oz -x r t Pic d hl Required Training References Frequency Training Date Employee Signature Instructor IIPP (Injury/Illness Prevention) CCR Title 8, GISO 3203 Initial Emergency Action Plan CCR Title 8, GISO 3220 Initial Fire Prevention Plan CCR Title 8, GISO 3221 Initial Hazardous Communication CCR Title 8, GISO 5194 `Initial Right to Know CCR Title 8, GISO 5194 Initial Lockout-Tagout CCR Title 8, GISO 3314 `Initial Personal Protective Equipment CCR Title 8, GISO 3380 'Initial Hazardous Material M mL HSC Section 25500 Initial Spill Prevention/Control Plan CRT Title 40, Part 112 Initial Hearinq Conservation CCR Title 8, GISO 5097 —Initial Respirator Protection CCR Title 8, GISO 5144 —Initial Fire Extinguisher CCR Title 8, GISO 5161 —Initial Ergonomics CCR Title 8, GISO 5110 Hazardous Waste Management CCR Title 22, 66265 —Initial 11 Lift Truck 29 CFR 1910.178 —Initial Hoist/Cranes CCR Title 8, GISO 4884 Initial Machine Guarding CCR Title 8, GISO 4243 —Initial Back Injury Prevention CCR Title 8, GISO 3203 Initial Fall Protection CCR Title 8, GISO Initial Blood Borne Pathogens CCR Title 8, GISO 5193 —Initial Code of Safe Practices CCR Title 8, GISO 3203 Initial Slips, Trips, & Falls CCR Title 8, GISO 3203 Initial Blocking & Cribbing CCR Title 8, GISO 3203 'Initial utner mequimu Iraoun . Smith System CHP Driver Training i NOTE: Retain this training form for duration employee is employed by Holt of California. Indicates additional training if new material/procedure is introduced to work area. " Indicates initial training if department employee reports a repetitive motion injury. — Indicates annual or refresher training required. NOTE: By signing this form, employee states he/she has received training in subject matter. FORM SA0001 Submit