HTML Preview New Employee Safety Orientation Checklist page number 1.
New Employee Safety Orientation Checklist
File this form in the Employee's Personnel Record
Name: ___________________________________ Job/Dept Assigned: ________________________________
Training Performed by
Topic HR Manager Supervisor
Yes No Yes No
General Safety Rules & Policies
General safety rules and policies specific to department or location.
Hazard Communication & Chemical Safety Procedures including how to read and locate information on
an MSDS form
Site specific MSDS location and uses
Hearing Conservation including how to insert and care for hearing protection
Areas or departments where hearing protection is to be utilized, where to obtain hearing protection and
who to contact with questions
Control of blood borne pathogens including how to clean up spills.
Control of blood borne pathogens including how to clean up spills, where supplies are located, and
who to contact should a spill need to be cleaned.
Electrical Safety & Lockout/Tagout
Electrical Safety & Lockout/Tagout including machine specific instructions, where supplies are located
and who to contact should assistance be needed.
Forklift safety and proof of prior certification
Forklift safety including review of controls, training, and proof of prior training
Fall protection basics
Fall protection including where equipment is located, training, identification of areas that fall protection
use is mandated
Ergonomics and how to reduce injury using correct ergonomic placement of all work items
Workstation that will be utilized, assistance with setting up workstation correctly for user
Basic Emergency Plans and when they are used
Emergency plan specific to location or department including routes and assembly locations, and how to
report emergencies.
Procedures for safety violations, accidents, near-misses
Procedures for safety violations, accidents and near misses specific to company, location or
department
Proper lifting & ergonomic techniques
Where lifting equipment is located, what jobs will require manual exertion exceeding 25 pounds, who to
contact for assistance, and company specific requirements regarding policies on lifting.
Tool & Equipment Safety including use and care
Tool & equipment safety including where to obtain tools, who will be responsible for maintenance and
purchasing tools
Safety Signs and their meanings
Tour of facility and discussion of all safety signs encountered including eyewash stations and showers.
I have received training on all checked items and agree to comply with all rules, regulations, and guidelines placed into effect by my employer and
their clients.
Employee's Signature ____________________ Date________________
Trainer Signature________________________ Date________________