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THE PAPE GROUP, INC.low �. REQUIRED SAFETY TRAINING FOR NEW MEMBERS Member Name: 8cenrkL � Hire/Transfer Date: Poi L, ACO-) Job Title: 0 aj(-e m f fl is4rQ f 0 Company/Location: QC2p��f S The member must be trained (or scheduled to be trained)in the following topics prior to beginning work. = Documentation of the training is required. > cc A Q H Note: Do not take your training and documentation responsibility lightly. Documenting that training and/or instruction has taken place can actually increase the ° as Completion company's liability if such training Is inadequate for the 4 � Date lob a ° w 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 PP /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 I 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: Date: This member has been trained in the above areas and I am confident in his or her knowled a of and competency in the areas requirin emo tratio f s ork prac Manager Signature: Date: