1. Employee:_______________________________________________________

2. First day in new work:__________________________________________(date)

3. Supervisor’s name:________________________ 4. Title: ________________

5. Work Area:______________________________________________________

6. Training date:____________________________________________________

7. Employee training provided:

8. Employee training provided:
 

MSDS                                                         Personal Protective Equipment

Labels                                                         Waste Disposal

Work Area Hazards                                   Chemical Hygiene Plan

Spill Control and Clean Up                       Work Area Safety Rules

Safety Equipment                                       Location of Reference Material

9. Additional safety and health information provided:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Completed By:                                                                      Date:

Employee’s Signature:                                                         Date: