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J THE PAPE GROUP, INC. REQUIRED SAFETY TRAINING FOR NEW MEMBERS Member Name: U p' �'�ZD�A �+/ e/Transfer Date: Job Title: Company/Location: ��C.��``Y� 0�—/Z1 The member must be trained(or scheduled to be trained)in the following topics prior to beginning work. 5 Documentation of the training is required. u Note: Do not takey our training and documentation responsibility lightly. Documenting that training and/or ,� E instruction has taken place can actually increase the � � y � 4) u Completion company's liability if such training is inadequate for the d Date job. a • Introduction to members and tour of facility X X I X X X —QZ— • Safety Attitude—Review Safety Polic #5.01 X X X X X —02-0 • Review General Safety Provisions(IIPP)/074AB14 • Housekeeping X X X X X Clear aisle was v Clear exits Clean up of spills Responsibility for your area ; • Violence Response Policy X X X X Xo7-oz—o-7 • Review Job Specific Job Hazard Anal 074AB15 • First Aid—location of kit,stretcher lanket,eyewash, X X X X X and deluge showers. First aid trained personnel. • Emergency Action Plan—911 X X X X X Poster with store address v Ambulance and Hospital Phone numbers Map of Store and exits,Meeting lace 1/ • 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 wor ctices and rules of behavior. � � �o Member Signature: Date: �d 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 dem tration of sae ork practices. Manager Signature:. Date: