SAFETY ORIENTATION CHECKLIST - USDA-ARS, Urbana, IL

Employee's Name ___________________________________________________________________________________

Job Title __________________________________________________ Date Hired ________________

General Instructions:
1. Read and review the safety information items provided by your supervisor which are appropriate to your work assignment.
2. Review emergency procedures and hazard communication training with your supervisor.
3. Indicate the completion of each activity by filling in the chart below.
4. Return this completed form to your supervisor within 30 days.

ITEM

INITIALS

1. Accident Reporting Requirements	_________
2. General Safety Rules	_________
3. Laboratory Safety Rules	_________
4. Safety Rules for Manual Workers	_________
5. Hazardous Waste Disposal	_________
6. Vehicle Operation	_________
7. Chemical Hygiene Plan - USDA and University of Illinois	_________
8. Special Equipment Training	_________
9. USDA Pollution Prevention Plan	_________

10. Read Emergency Response Plan (Tornado and Fire Evacuation Plans, Fire Safety in the Work Place)	_________
11. Know the meaning of emergency warning signals in your work area.	_________
12. Know the location of: fire alarm, fire extinguishers, exits, first aid kit, emergency shower and eyewash	_________
13. Know how to get help in case of emergency	_________
14. Inform supervisor of any medical problems	_________

 

 

 

 

HAZARDOUS MATERIALS AWARENESS
Your supervisor will review with you the hazardous chemicals in your work area that you may be exposed to.

15. Identify hazardous chemicals in your work area	_________
16. Know what safety procedures should be followed and what protective equipment should be used	_________
17. Know how to obtain chemical safety information through use of Material Safety Data Sheets (MSDS) and other references	_________

 

 

 

I have read the information indicated by my initials in the chart above and understand their meaning and intent. I assure my co-workers and supervisor that I accept and will apply these rules to my work.

_________________________________	____________________
Signature of Employee/Date	Signature of Supervisor/Date