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This form documents that the training specified above was presented to the listed participants. By signing below, each participant acknowledges receiving this training. Organization: Plymouth Square — Skilled Nursing Trainer: Tyah Petersen/Charlene Lovelace/Victoria Rodriguez/Yeraldin Acevedo Trainer's Signature: te' Topic: _Consolidated Eme`r ency Response/Contingency The following topics have beero addressed: Plan iGl iz 12 � 1. Emergency Response/Contingency Plan a"" 11 Environmental Health 2. Spill notification procedures -Call 911, call facility management 3. Spill response procedures -Contain per protocol 4. Evacuation procedures -Evacuate to parking lot Class Participants Name: "�zss�lra Iq�^�``�S Signature: ,,,w— Department: Yluvs� NameC )" yyi' ,� ignature: �'rV � Department: (V� p (\/h2s Name: IVI�� l�Wll (vf5ignature: Department: v Name:Wl �MAU`tur h Signature: Vvv " Department: �US'IivLSS Name: Signature: Department: Name: Signature: Department: Name: rt ment: Business plans shall include provisions for ensuring that appropriate personnel receive initial and annual refresher training. All employees shall be trained in safety procedures in the event of a release or threatened release of a hazardous material, including, but not limited to, familiarity with the following plans and procedures: 1. Immediate notification contacts to the appropriate local emergency response personnel and to the unified program agency. 2. Procedures for the mitigation of a release or threatened release to minimize any potential harm or damage to persons, property , or the environment. 3. Evacuation plans and procedures, including immediate notice, for the business site. This training shall be documented electronically or by hard copy and shall be made available for a minimum of three years. Immediately provide employee training for appropriate personnel and submit a copy of the training records to the Environmental Health Department.