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EMPLOYEE PESTICIDE SAFETY TRAINING RECORD /WRITTEN TRAINING PROGRAM
<br /> FMPLOVERS NAME: M VL S ASSIGNED JOB Specific Pesticides
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<br /> i�l►rrI oYE>�NAME: IVC� � DUTIES:
<br /> Mixer/Loader [�
<br /> EMPLOYEE Service/Repair C]
<br /> SIGNATURE: d Is.
<br /> Applicator �
<br /> DATE: L Flagger [] a
<br /> TRAINFR'S Other(Specify) [� q
<br /> NAME: MI
<br /> r a' Trainer's Initial
<br /> Employee's Initial
<br /> Date:
<br /> TRAINING RF,QUIRFMF.NTS AND INFORMATION/MATERIALS USIf
<br /> IN TRAINING PROGRAM
<br /> WEAR CLEAN COVERALLS DAILY: Provided and cleaned by employer for Warning and Danger pesticides, ASIS A-1 or N-1
<br /> SAFE IIANDLING PROCEDURES: Ilow to open and lift containers,pour and operate mixing and application equipment. 9^
<br /> TRIPLE RINSING; How and when to triple rinse contnlners. Proper disposal of containers. PSIS A-2 orN-2
<br /> DRIFT;Ilow to confine spray to target arca;how to avoid contamination of people,animals,waterways and sensitive areas, ;• ,�
<br /> STORAGE: How and where to store contniners;procedures to follow when containers cannot be locked up, PSIS A-2 or N-2
<br /> PERSONAL HYGIENE: Importance of washing hands thoroughly before eating,smoking,drinking or using the bathroom;need to shower thoroughly I
<br /> when I-mished workingfor the do ,
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<br /> EMERGENCY MEDICAL MhORMA illness
<br /> Posting of name,address and telephone number of Inc clinic,physician or hospital emergency room; ^
<br /> con an otic Porro reporting in' or illness and obtainin culmens. PSIS A-4 or N-4 t/
<br /> HEAT STRESS: Recognition,treatment and prevention. PSIS A-1 orN-I
<br /> EMPLOYEE RIGHTS: Right to receive information--regarding
<br /> g g pesticides to which they may be exposed;protection against discharge or other
<br /> discrimination due to exercisin these ri hts. PSIS A-$or N-R ? ,�•'
<br /> LOCATION OF DOCUMENTS: Location of and access to Hazard Communication Pro1 !
<br /> other documents, PSIS A-8 or N-8 gram,labels,PSISs,pesticide Ilse records,medical records and {; `
<br /> LABEL: Signal words,precautionary statements,first aid instructions,application rate and mixing and npplicetiort instructions. Specific label and
<br /> PSIS A-1 or N-1
<br /> PERSONAL PROTECTIVE EQUIPMENT: The proper use and cnre of coveralls,gloves,eye protection,hoots,apron crud other equipment provided h ✓ V
<br /> employer. S ecific label PSIS A-1 or N-1 P
<br /> RESPIRATORY EQUIPMENT: Fit,use,maintenance,and disinfbetion. Written Respiratory Protection Program,Spcciiic label,PSI5 Ars or N-5 and
<br /> oro, irator manufacturer recommendation. /
<br /> ENGINEERING CONTROLS: When and how to use enclosed cabs,closed mixing systems,water sohunblc bags and other equipment. Specific label,
<br /> PSIS A-3 or N-3
<br /> FIRST AID AND DECONTAMINATION PROCEDURES: If, nid for skin,eye,inhalation and ingestion exposure, PSIS A-4 or N-4 and Inbcl
<br /> instructions
<br /> EMERGENCY PROCEDURES; The procedures for handling non-routine tasks or emergency situations such as spills,leaks or fires. MSDS b ;r i
<br /> IMMEDIATE SYMPTOMS AND LONG-TERM HEALTH EFFECTS: Routes Ofexposure,immediate health hazards and symptoms of exposure and
<br /> ton -form health effects. Label and MSDS ;{
<br /> MEDICAL,SUPERVISION: Pesticides that require medical supervision;when medical supervision is required,and general provisions of medical V;; / ,
<br /> su myon, PSIS A-11
<br /> V v
<br /> LAWS AND REGULATIONS: Applicable laws and regulations and IIIc importance of compliance by employer and worker. PSIS A 1-11 or N 1-10
<br /> OTHER TRAINING MATERIALS USED OR INFORMATION PROVIDED:(i.e.videos,Pamphlets,study guides,company policies) hr
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