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This form documents that the training specified above was presented to the listed participants. By signing below, each participant acknowledges receiving this training. Organization: Plymouth Square— Skilled Nursing Trainer: Tyah Petersen/Charlene Lovelace/Victoria Rodriguez/Yeraldin Acevedo Trainer's Signature: r Date: Topic: _Consolidated Emergency Response/Contingency Plan The following topics have been addressed: 1. Emergency Response/Contingency Plan Training -County Environmental Health 2. Spill notification procedures -Call 9111 call facility management 3. Spill response procedures -Contain per protocol 4. Evacuation procedures -Evacuate to parking lot Class Participants: NaaP.4 -c Ca Z S l.v Signature: Department: �/�{«"r/'z�`� � Name: ff 11 ° �r ` �SignatU� �l Department: i I� {"ll� Na I l Ut f1 ig at Department: e%N7 Ulcer Name: ha f)P%��nture: Department Name: I/z�4V �S�ignature;� f'7 ��Department. Name: Signature: Department: Name: Signature: Department: Business plans shall include provisions for ensuring that appropriate personnel receive initial and annual refresher training. All employees shall be trained in safety procedures in the event of a release or threatened release of a hazardous material, including, but not limited to, familiarity with the following plans and procedures: 1. Immediate notification contacts to the appropriate local emergency response personnel and to the unified program agency. 2. Procedures for the mitigation of a release or threatened release to minimize any potential harm or damage to personsI property, or the environment. 3. Evacuation plans and procedures, including immediate notice, for the business site. This training shall be documented electronically or by hard copy and shall be made available for a minimum of three years. Immediately provide employee training for appropriate personnel and submit a copy of the training records to the Environmental Health Department.