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;2, S <br /> 1 <br /> � F ; <br /> +c•� jqa, ...�')F�r./'F� �,C....%i� �F:.j j../�r n.F F ..`.! :-Gr...1 i <br /> v <br /> 7 <br /> .:. .. ..::i:''....:::::::i <br /> .�' :';i:::.,. ::::::::.�::::::::::v::iY:-ii:i.::.: ......... <br /> :.:..........................:::W::::;;... <br /> ...................... <br /> Former k MU^P Model Project Safety Plan <br /> PARSLJIMS <br /> r € s <br /> 0 <br /> Name of Trainer: <br /> Training Subject: 17 <br /> Training materials used. <br /> Name of employee: <br /> Date of hire/assignment: <br /> hereby certify that I have received training as described above in the following areas: <br /> Names of personnel responsible for site safety and health. <br /> Safety,health or other hazards at the site. <br /> The proper use of personal protective equipment. <br /> The potential occupational hazards in general in the work area and associated with my job assignment. <br /> Work practices by which a worker can minimize risks from hazards. <br /> Safe use of engineering controls and equipment on the site. <br /> Acute effects of compounds on the site. <br /> Decontamination procdures. <br /> General safety requirements indicate the safe work conditions,safe work practices and personal protective equipment <br /> required for my work. <br /> The hazards of any chemicals to which I may be exposed and my right to information contained on material safety data <br /> sheets for those chemicals,and how to understand this information. <br /> My right to ask questions,or provide any information to the employer on safety either directly or anonymously without <br /> any fear of reprisal. <br /> Disciplinary procedures the employer will use to enforce compliance with general safety requirements. <br /> I understand this training and agree to comply with general safety requirements for my work area. <br /> � v <br /> 001 <br /> F <br /> p � F <br /> i <br /> y <br /> Employ Signature Date <br /> ............ ... .. .r...r..j:.. ./. .:......F r........F...j/.:./..n:rr:.F..... :.fl:..F/./.i�:.:l�:.:F.:.9F�;:rr...:c::•%r.. ..N';:r%�',"i':.j1..: <br /> ................r., r.:.:...:r..:.:rr . F r r .r r Fi..✓ r .::!..:r.....r..:.....:.:,.i.,r.1...r...:...rr.::r/r! ..:.:.::................/.rfl/ <br /> ::.:r...........:.,r ..•..r F.:. :F/.:>;.:.r:....,,...:.: .�...r'r:. ,.r.,a..r::F N .:.F;:../:::,+r...:.jr/r..nf:/./l ...fiF.rY:..r.�..�l:i:... ..l.�.l..r...r..1..r.....l.:il........:....:.)......:.......r...:/..?,,:::..........:�r.:.....r....r., F <br /> ::r:::r::::::::,r:•:.F•.r/Fr:.F:.:ji':.:i,n.<:••:r.+n:F:.nrr::il.•..!Fr::.3':ci:.t,.;:„r.:.f:"F:/.r�..:.,,:..::...::/;.!.:,.,.rr/��.:�/n�::::r/:.::�.//'-�l/•/jH`1.j/.iF.!/F���i...),......././:,....:.......N:./..rr.....rr...:F�ii:.....:....:....:.r..r...,........r....,...�.r:.r...:.....:F...�:..rr .. <br /> :::�•::::r.::::rS.k<:f.:�r.::•'.•j1:i•:�•:�•...::.....,:r.'......:rf r�.F.r........:�...:......::r.r..::...r.:.r..//..1::.:......... .... <br /> A-1 <br />