ࡱ> :<9q` abjbjqPqP 4$::a  $ $*2 L$ $ $ $  Zq 4 $\hw}  ww$ $ Yw$ $ w:,-$ Y,z   0*RRHR-R-|    *wwww   Injury & Illness Prevention Program NEW EMPLOYEE SAFETY TRAINING RECORD  Department: ___________________________________________________________________ Instructor/Supervisor: ____________________________________ This completed form should be retained in the individuals personnel file as evidence of initiating training required under the Injury and Illness Prevention Program. Employee Name: _______________________________________  FORMCHECKBOX  New Hire  FORMCHECKBOX  Transfer  FORMCHECKBOX  Other: ________________________________ Date of Hire/New Assignment: _______________________ I, ______________________________________, hereby certify that this employee has been (Instructor) trained on the following: (Check appropriate boxes). I.  FORMCHECKBOX  Initial Training on Departments IIPP, including: Date: _______________ Employees right to ask any question, or report any safety hazards, either directly or anonymously without any fear of reprisal. The location of university and departmental safety bulletins and required safety information (i.e., summary of occupational injuries and illnesses, Intranet training materials, and Safety and Health Protection Poster). Disciplinary procedures that may be used to ensure compliance with safe work practices. Need and procedures for reporting safety concerns. Accessing the department safety committee. Procedure for reporting occupational injuries and illnesses. II.  FORMCHECKBOX  Hazard Community Training Date: _______________ The potential occupational hazards in the work area associated with the employees job assignment. Safe work practices and personal protective equipment required for the employees job title. The location and availability of Material Safety Data Sheets (MSDS), if any. The hazards of any chemicals to which the employee may be exposed, and the employees right to the information contained on MSDSs for those chemicals. III.  FORMCHECKBOX  Other: _______________ Date: _______________  I certify that I have received the above information Employee Signature: ___________________________________ Date: _______________  IIPP Form 7 Completed copies of this form must be kept in Department files for at least one year. 6/7/04 For questions on any item, please contact your Department Safety Coordinator or call EH&S at 642-3073.   #$%HIJKX~   , L ļļijļī{i#jhxahxaCJUaJ#jthxahxaCJUaJ#jhxahxaCJUaJjh_ahCJUaJh_ahCJaJh5CJaJh~CJaJhCJaJ"jh_ahCJUaJmHnHuhCJ aJ h5CJ aJ hhhh5)$%IK - d e f  h X@gdcM  X@gd_ah p X@@gd~ p X@@<gd~ p@gd~ $ p@Pa$gd~ p@gd~ p@Pgd~$a$gdaL c f g h k }     X r s }   ĹıĞ𖊖xĖpeZOph$hOQCJaJh$h?jCJaJh$h=XCJaJha(CJaJ#j\hxahxaCJUaJjh?jCJUaJh?jCJaJh=2CJaJh=2hcMCJaJhcMCJaJh=2h_ahCJaJhcMCJaJ"jhcMCJUaJmHnHu"jhrgCJUaJmHnHuh_ahCJaJh~CJaJ   s ' Z n~$ & F 8 X@8^8a$gda($ 8 X@a$gdcM$  X@a$gd$$ & F 8 X@8^8a$gd$$  X@a$gdcM h X@gd_ah  E P ' @ ./Oamno>J_m{ϱϩ틡{o{jhVCJUaJhVCJaJh=2CJaJhVhVCJaJhVhVCJaJhVCJaJhcMCJaJ#jhxahxaCJUaJjh$CJUaJh$CJaJh$h$CJaJh$h=XCJaJha(CJaJh$hOQCJaJ*n./$ 8X@a$gdI$ 8 X@a$gdV$ 8 X@a$gdcM$ & F 8 X@8^8a$gdV$ & F 8 X@0`0a$gdV-./sW_aٿٴѡxofZLZ *h=2h=25CJaJh=2h=25CJaJh=25CJaJhN5CJaJhNhNCJaJhICJaJ *h=2hN5CJaJhNCJaJhVhVCJaJhVCJaJha(ha(CJaJ"jhrgCJUaJmHnHuhcMCJaJhVCJaJjhVCJUaJ#jDhxahxaCJUaJa$ 8 X@a$gdV21F:p$/ =!"#$% tDeCheck1tDeCheck2tDeCheck3tDeCheck4tDeCheck5tDeCheck6H@H Normal CJOJQJ_HaJmH sH tH DAD Default Paragraph FontRiR  Table Normal4 l4a (k(No Lista $$%IK-defs'Z n./c 0P0000000000000000 0 0 0 0 0 000 0 0 0 00000@0000000000000L  a  na a  a G$G$G$G G G 8@(  6    HB  C DHB  C DHB  C DHB  C DB S  ?Ifga p& tS?tp&Sp&?tp&t`p&`tCheck1Check2Check3Check4Check5Check6 c c {g!c c 8*urn:schemas-microsoft-com:office:smarttagsdate f200467DayMonthYearc c fghh s}EP'@./Oano>J_m.//` c c FttJ$ h^`OJQJo(hHh^`OJQJ^Jo(hHoh  ^ `OJQJo(hHh^`OJQJo(hHh[[^[`OJQJ^Jo(hHoh++^+`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHhpp^p`OJQJ^Jo(hHoh@ @ ^@ `OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHhPP^P`OJQJ^Jo(hHoh  ^ `OJQJo(hHFtJ$                  IV9QOQ=Xrg_ah?jn~=2Nma(V6` xacMP$@:a @UnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New;Wingdings"qhⓥⓥff$xr4d] ] 2QXZ-?9Q2#Injury & Illness Prevention Programbcarterjkellogg  Oh+'0( <H h t $Injury & Illness Prevention Programbcarter(New_Employee_Safety_Training_Record.dot jkellogg2Microsoft Office Word@F#@