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NEW EMPLOYEE SAFETY CHECK LIST <br />This report is to be completed by the Supervisor and the new <br />employee within five (5) days after employment and filed in the <br />employees personnel file located in the office. <br />Name <br />1lt11C+ r1Mx'LV1z1/ ulftlz <br />LIST COMPLETED <br />PROBATIONARY PERIOD IS FROM <br />FIRST MIDDLE LAST <br />TO <br />SUPERVISOR WILL FORMALLY REVIEW EMPLOYEE'S PERFORMANCE ON: <br />(Mark Calendar) <br />DEPT. ASSIGNED <br />TYPE OF WORK <br />ASK EMPLOYEE: "Do you have any physical conditions or handicaps <br />which might limit your ability to perform this job? If so, what <br />reasonable accommodation can be made by us?" (Question approved by <br />Department of Fair Employment and Housing). <br />DID EMPLOYEE HAVE A PRE -PLACEMENT PHYSICAL? YES <br />IF YES, ANY WORK RESTRICTIONS INDICATED? <br />THE SUPERVISOR AND THE NEW EMPLOYEE ARE TO REVIEW THE FOLLOWING <br />SAFETY CONCERNS, CHECK AND DISCUSS THOSE WHICH APPLY: <br />1. High priority this company give to safety. <br />2. Company safety policies and programs. <br />3. Safety rules, both general and specific to job <br />assignment. <br />4. Safety rule enforcement procedures. <br />5. Personal protective equipment that must be worn (when, <br />where and why): <br />Safety Boots Goggles/Face Shields <br />Hard Hat Safety Vest <br />Respirator Ear Plugs/Muffs <br />6. Safe operation of the following vehicles/equipment: <br />