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Resrtttl: Employee Cal/OSHA, Cal/EPA Training Record EMPLOYEE NA : Last, First, MI. (Print) Employee # Job Title TC, oesC P -f t3 l t c Fm 1) 5,7 SGC �n DIVISION / DEPARTMENT LOCATION 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 I 1`" I /, Campbell Personal Protective Equipment CCR Title 8, GISO 3380 'Initial , —.- Campbell Hazardous Material Mgmt. HSC Section 25500 Initial inb Campbell Spill Prevention/Control Plan CRT Title 40, Part 112 Initial 1 G" Campbell Hearing Conservation CCR Title 8, GISO 5097 "'Initial Campbell Respirator Protection CCR Title 8, GISO 5144 "`Initial Campbell Fire Extinguisher CCR Title 8, GISO 5161 "'Initial ' - Campbell Cam p Ergonomics CCR Title 8, GISO 5110 — Campbell Hazardous Waste Management CCR Title 22, 66265 —Initial Campbell Lift Truck 29 CFR 1910.178 "`Initial Hoist/Cranes CCR Title 8, GISO 4884 Initial D / - Campbell Machine Guarding CCR Title 8, GISO 4243 "`Initial Campbell Back Injury Prevention CCR Title 8, GISO 3203 initial i Campbell Fall Protection CCR Title 8, GISO Initial l Campbell Blood Bome Pathogens CCR Title 8, GISO 5193 "`Initial J Campbell Code of Safe Practices CCR Title 8, GISO 3203 In Slips, Trips, & Falls CCR Title 8, GISO 3203 Initial /� ��- Campbell Blocking & Cribbing CCR Title 8, GISO 3203 Initial Campbell Office Safety / �� Campbell Employee Handbook Campbell 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 Distracted Driving 8asic First Aid Weather Conditions 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