AAC Safety Orientation Form
Part A
PROCEDURE: This form must be completed by all individuals working in laboratories (i.e., employees, students,
visiting scientists, and volunteers engaged in research). Orientation activities may be delegated to a qualified
individual; however, the facility director is ultimately responsible for training and must ensure that this form is
completed, signed, and certificates for EHS training modules are submitted electronically to the AAC Manager.
Access to the lab will not be permitted in advance of this safety verification.
Name:
Position:
ID:
Start Date:
Email:
Facility Director:
WORKPLACE ORIENTATION AND SAFETY EXPECTATIONS:
Facility Director (or designate):
I have shown the individual the location and proper use of:
• Alarm pull stations, emergency exits and safe gathering areas
• Phones and emergency call boxes
• Natural gas shut off and breaker panel
•
Emergency equipment (first aid kit, spill kit, eyewash station, safety shower, fire extinguisher, AED)
• Health & Safety bulletin board with posted safety contact information
I have advised the individual of actual and potential hazards in the work area and the appropriate precautions
(these may include; biological, chemical, electrical,
mechanical, radiation and temperature extremes).
I have discussed lab-specific standard operating procedures and have ensured that written procedures are
available in a well-marked location in the laboratory.
I have ensured that Safety Data Sheets are available for all chemicals in the laboratory.
I have ensured that contact information for Emergency Dispatch is posted in the lab.
I have explained the process for separating waste and disposing of hazardous waste.
I have explained the requirements of proper attire and personal protective equipment.
I have explained the safety precautions for working alone or work after hours (hazard assessment, buddy
system, access control, SafeWalk, notification of Campus Community Police).
I know where to locate the Occupational Health and Safety Act (OHSA).
I have reviewed EHS Policy 851.01.01.
I have reviewed and understand the information contained in the AAC Safety Handbook and website.
I am aware of the location of written lab-specific safety procedures, and that I am always required to follow
these prescribed safety procedures.
I have been instructed in the proper use of emergency equipment and am aware of its location.
I have reviewed the emergency response procedures posted in the lab.
I understand the actual and potential hazards in the work area.
I am aware of basic lab safety rules (no food/drink, proper attire, PPE, no door propping, good
housekeeping).
I understand the process for separating waste and disposing of hazardous waste.
I understand that I am to call 52000 during emergencies and how to contact:
• Campus Community Police (non-emergencies) ext. 52245 or 519-820-5000
• Environmental Health and Safety: ext. 53282
• AAC Safety Representative
I understand the prohibited working alone or after hour activities as presented in Working Alone Guidelines.
MANDATORY SAFETY TRAINING:
Lab Personnel: I have provided the date when each training course was completed.
Lab Personnel Signature:
Date:
Trainer Signature:
Date:
Director Signature:
Date:
This record is to be kept in the Lab Safety Binder and a copy submitted to the AAC Manager May 2019
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