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This form documents that the training specified above was presented to the listed participants. By signing <br />below, each participant acknowledges receiving this training. <br />organization: Plymouth Square — Skilled Nursing <br />Trainer: Tyah �en/Charlene Lovelace/Victoria Rodriguez/Yeraldin Acevedo <br />Trainer's Signature: Date: <br />Topic: _Consolidated Emergency Response/Contingency Plan <br />The following topics have been addressed: <br />i. Emergency Response/Contingency Plan Training -County Environmental Health <br />2. Spill notification procedures -Call 911, call facility management <br />3. Spill response procedures -Contain per protocol <br />4. Evacuation procedures -Evacuate to parking lot <br />Class Participants: <br />�eseparif <br />I <br />Ir!_ <br />y <br />�.. ep WPO <br />Name e Department: <br />r_ <br />1.n- l/ Sianature: _ Dep <br />Name: Signature: Department: <br />Department: <br />Name: Signature: Department: <br />Business plans shall include provisions for ensuring that appropriate personnel receive initial and annual refresher <br />training. All employees shall be trained in safety procedures in the event of a release or threatened release of a <br />hazardous material, including, but not limited to, familiarity with the following plans and procedures: <br />1. Immediate notification contacts to the appropriate local emergency response personnel and to the unified <br />program agency. <br />2. Procedures for the mitigation of a release or threatened release to minimize any potential harm or damage to <br />persons, property, or the environment. <br />3. Evacuation plans and procedures, including immediate notice, for the business site. <br />This training shall be documented electronically or by hard copy and shall be made available for a minimum of three <br />years. <br />Immediately provide employee training for appropriate personnel and submit a copy of the training records to the <br />Environmental Health Department. <br />