NAME:_________________________________ S.S.#:______________________

JOB ASSIGNMENT:_______________________ Supervisor:___________________

EMPLOYMENT DATE: _______________________________________________

COMPLTED BY EMPLOYEE DEPARTMENT:
 
 

A. During First Week of Employment
 

Management’s safety and health philosophy

Management’s, supervisor’s, and employee’s safety and health responsibilities

General university safety and health rules

Chemical Hygiene Training Program

Location and availability of Chemical Hygiene Plan
 

B. First Day In Work Area                                                       Date:__________________
 

Introduction to operations where chemical and physical hazards are present - types of hazards encountered

Required work practices

Personal protective equipment

Emergency procedures

Detection of chemical hazards

Location and availability of Chemical Hygiene Plan
 

C. One Week Follow-up                                         Date: ___________________

Review work practices and procedures with employee

Answer employee questions

Return completed checklist to Chemical Hygiene Officer for filing

Completed By:                                                                            Date:

Employee’s Signature:                                                               Date: