NEW EMPLOYEE ORIENTATION FORM

DATE:                                                     

EMPLOYEE NAME:                                                                                                           

EMPLOYEE SOCIAL SECURITY NUMBER:                                                                     
DATE OF HIRE:                                                                                                                

I, the undersigned, acknowledge that I have received employee orientation and training in the following:

									Yes		No

1.	Emergency Evacuation Routes				___		___	           
2.	General Safety						___		___      

3.	Fire Extinguisher Locations				___		___

4.	Pull Station Locations					___		___

5.	First Aid Locations					___		___ 

6.	Lifting Safely						___		___

7.	Portable Fire Extinguishers				___		___

8.	Hazard Communication (Chemical Safety)		___		___

9.	Lockout/Tagout						___		___

_______________________________________		__________________
(Employee Signature)						(Date)

_______________________________________		__________________
(Trainer)                                       				(Date)