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t v THE PAPE GROUP, INC. REQUIRED SAFETY TRAINING FOR NEW MEMBERS Member Name: G h r l� Ub hA So n Hire/Transfer Date: (9/16 f o Y l2.ThJob Title: P/Vfc e l;Very, dr., Vee Company/Location: D�/ — / 2— The e member must be trained(or scheduled to be 0 trained)in the following topics prior to beginning work. C° Documentation of the training is required. Note: Do not take your training and documentation y A O H responsibility lightly. Documenting that training and/or ,� 3 instruction has taken place can actually increase the Completion company's liability if such training is inadequate for the d C-0 Ln A Date job. a, a • Introduction to members and tour of facility X X X X X • Safety Attitude—Review Safety Policy#5.01 X X X X X • 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 Analysis/074AB15 • First Aid—location of kit,stretcher,blanket,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 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: azo- 1 � Date: 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 demos atiou of s f work practices. Manager Signature: Date: �-16 D g