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THE PAPE GROUP, INC. REQUIRED SAFETY TRAINING FOR NEW MEMBERS Member Name: .5 1Fm5r ,;�99/dl r Hire/Transfer Date: - 7 i Job Title: Ti5UCz- Company/Location: ��cJG CtJM�The member must be trained (or scheduled to be trained)in the following topics prior to beginning work. d Documentation of the training is required. o L - a U Note: Do not take your training and documentation y A O ^ responsibility lightly. Documenting that training and/or �+ instruction has taken place can actually increase the ,b a Completion company's liability if such training is inadequate for the Q R Date job. a a • Introduction to members and tour of facility X X X X X - -7 • Safety Attitude-Review Safety Policy#5.01 X X X X Ix -7- o • Review General Safety Provisions(IIPP)!074AB14 • Housekeeping X X X X X Clear aisle ways Clear exits Clean up of spills Responsibility for your area = • Violence Response Policy X X X X X • Review Job Specific Job Hazard Anal i 074AB15 • First Aid-location of kit,stretche , lanket,eyewash, X X X X X and deluge showers. First aid trained personnel. Ldp • Emergency Action Plan-911 X X X X X Poster with store address Ambulance and Hospital Phone numbers Map of Store and exits,Meeting lace • How to report on the job accidents,incidents,and near X X X X X accidents �' �� • Have Member attend the first safety meeting held after X X X X X date of employment I acknowledge I have received the above training,that I questioned what I did not understand,and that I agree to abide by prescribed work practices and rules of behavior Member Signature: Date: i ' 7 yio� This member has been trained in the above areas and I am confident in his or her knowledge of and competency in the areas requiring demonstr ionof fie work practices. Manager Signature: Date: Ziva�