Employee Safety Training Checklist Template - Offices printable pdf download

FORM: A (Rev. 10/16) UCSB Injury and Illness Prevention Program

_____________________________________________________

EMPLOYEE SAFETY TRAINING CHECKLIST: OFFICES

(Supervisor should file this form for each employee and update as needed)

Under California law and campus policy, supervisors must provide documented safety training for: new

employees; employees given new job assignments for which training has not previously been received; whenever

new hazards are introduced, or are recognized. Training can be formal or informal, and individual or group‐based.

This checklist provides a good start towards documenting training but it may not address every possible safety issue

in the workplace. Also, there is a separate training checklist for

shop/trade

personnel, please do not use this checklist

for these individuals. Questions on this program should be directed to your local Department Safety Representative

(DSR), or EH&S (x‐4899).

Employee Name ________________________

Job Title___________________

Supervisor Name _______________________

Job Title___________________

General Safety:

(applies to all)

Per specific Cal‐OSHA regulations, all campus employees must receive documented training on the UCSB safety

programs listed in this box. Most of the required training is covered FOR supervisors by having the employee view

one of the modules

(footnote

#2). It is strongly recommended that all individuals view their respective modules

BEFORE completing this form. Mark off all items listed below with the employee:

employee has viewed either training module:

Non-supervisor (TR-29): Safety Rights & Responsibilities

Office Supervisor (TR-25): Safety Rights & Responsibilities

DATE module was taken:_______________

knows the UCSB Health & Safety binder is located: ________________________

reviewed the Department’s Emergency Action Plan

knows the location of written Department IIPP

reviewed role and identity of our Departmental Safety Representative

reviewed the function/location of the

Hazard Reporting

form

reviewed the function/location of the Department Safety Bulletin Board

Specific Safety Issues:

For Further Information:

(if applicable)

Ergonomic issues (e.g. workstation evaluation.; back safety)…….. EH&S Ergonomics Coordinator

Campus smoking policy

…………………………………………….No smoking in campus buildings

Other Applicable/Local Safety Training: e.g., personal protective equipment; Safety Data

Sheets for chemical users, etc.

(note the subject/date/trainer)

______________________________________________________________________________________

I understand this training and agree to comply with safe work practices.

_______________________ __________

__________________

________

Supervisor’s signature

Date

Employee’s Signature

Date

----------------------------------------------------------------------------------------------------------------------------- -----

Footnotes:

1. This document and the associated Self-Inspection Checklist: Offices can be found at:

click

on: “Health and Safety Binder”, then “Injury and Illness Prevention Program”– checklists are in IIPP Appendices

2. Modules can be found at:

/training/srr.html

Employee Safety Training Checklist Template - Offices

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