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zAgIDOUS MATERIALS BUSINESS PLAN <br />SA PLOYEE TRAINING RECORD <br />FACILITY EM Agencies or where approved by your Local Jurisdiction <br />J s Member Ag CR <br />4u1110rity Cited., <br />For use by Uni oe <br />California Health and Safety Code Chapter 6.95 (HSC); Title 19 California Code of Regulations (C <br />Facility Name: <br />Site Address: <br />,alifomia Health and Safety Code §25507(x) <br />and Title 19 California Code of Regulations §2651(a) require that a <br />lan <br />in <br />dous Materials Business Plan (HMBP) Taking intofacility accounnt t the portion of each e ployee,, including the training ptrain ng for specified w <br />Nazar 25505(x)(4) and 19 CCR §2659(x)(4). g <br />NSC § provided in safe rocedares in the event of a release or threatened release of a hazardous <br />employees must be p <br />safety p <br />material. Annual refresher training isth quire <br />ars must be kept available or 1rlspe d. This training must be documented or by tar copy <br />records. Training records for the past y <br />Olgp training must include, but is not limited to, the following: <br />❑ Methods for safe handling of hazardous materials; <br />❑ Identification of areas of the facility and mechanical or other systems that require immediate inspection or <br />isolation because of their vulnerability to earthquake related ground motion; <br />❑ Evacuation plans and procedures, including immediate notification, for the facility; <br />❑ Identification of local emergency medical assistance appropriate for potential accident scenarios; <br />❑ Notification of local emergency response personnel, the Unified Program Agency, the California Emergency <br />Management Agency, and persons within the facility who are necessary to respond to an incident; <br />❑ Emergency response and safety procedures for the mitigation, prevention, and abatement of a release or <br />threatened release to minimize harm or damage to persons, property, or the environment; <br />❑ Use of the facility's emergency response equipment and supplies; <br />❑ Procedures for coordination with local emergency response organizations. <br />M <br />S . - City: <br />1 c � {vt M lQj 'S`f <br />Tt— f„n,,.ir;ncr Pr„ninvees have been trained as required by HSC §25507(a) and 19 CCR §2651(a): <br />Employee <br />Training Date <br />Trainer Name <br />/Name l� <br />Q <br />`tZS <br />k - <br />�s <br />m r,� LA <br />Cab Z, -Z, A, <br />s <br />-Z,?- A <br />S Ari4J i t\ V- <br />C, -zz <br />(Continued on reverse) <br />1/2 - Rev. 06/28/17 <br />