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A A— THE PAPE GROUP, INC. REQUIRED SAFETY TRAINING FOR NEW MEMBERS Member Name: n c V i d u Hire/Transfer Date: / N � � Job Title: I/M t aGY�L�,A t c- Company/Location: The member must be trained(or scheduled to be a trained)in the following topics prior to beginning work. Documentation of the training is required. Note: Do not take your training and documentation A p F responsibility lightly. Documenting that training and/or instruction has taken place can actually increase the ,U. ° Completion company's liability if such training Is inadequate for the 4 `� `" Date Ca Q to job. a a = • Introduction to members and tour of facility X X X X X OB – • Safety Attitude–Review Safety Policy#5.01 X X X X X 17-4297 • Review General Safety Provisions(HPP)/074AB14 ^O • Housekeeping X X X X X Q 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 ki�,stretche , lanket,eyewash, X X X X X and,deluge showers. First aid trained personnel. ' • Emer ency 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 r'e'ceived the above training,that I questioned what I did not understand,and that I agree to abide by prescribed work actices and rules of behavior. / p Member Signature: Date: This member has been trainenth above areas and I am confident in his or her knowledge of and competency in the areas requiring de ons alio f safe ork practices. Manager Signa re: Date: