New SSO for Roberts Company

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Hidden

Employee ID

Employee Orientation Check List – Safety

Tab 16G

Employee Name

First Last

Date of Hire

MM slash DD slash YYYY

Company

Project

This Check list is a guideline for conducting employee safety orientations for employees new to this Aldrich + Associates’ project. Once signed by both the Safety Representative and the Employee, it serves as documentation that the orientation has taken place.

Place a check in the box to indicate that the subject was discussed:

Explain the company safety program including:

Overview of the Site Specific Safety Manual

Safety Meetings

Safety Committees (if required)

Substance Abuse Policy

Review General Safety Rules

Disciplinary Procedures

- Serious consequences for horseplay / Fighting / Drug & Alcohol Use.
- Smoking Policy
- Good Housekeeping Practices

Discuss Personal Protective Equipment Required

Proper attire

Hard Hats and Safety Glasses

Orange Vests or Bright Colored Clothing

Lines of Communication and Responsibility for Immediately Reporting Accidents

When to report an injury

To whom an injury should be reported

Filing of accident report forms

First Aid Supplies, Equipment and Training

Location of all First Aid Stations

Obtaining Treatment

Proper Lifting Techniques

Proper Lifting Techniques

Description

By placing a signature below, the employee acknowledges that they will abide by the Guidelines contained within the Site Specific Safety Plan and report any condition or activity perceived to be unsafe to my immediate supervisor or the Site Safety Representative.

Employee Signature:

Safety Supervisor Signature:

Date

MM slash DD slash YYYY