Employee Safety Orientation Checklist

Department: Nursing – Direct Care staff. Employee is to initial each box

Employee Name:

Checklist

1. General safety policy

2. Proper body mechanic procedures

3. Safety rules – General

4. Safety rules - Specific to job

5. Employee counseling (discipline for safety policy violations)

6. Fire prevention, location of firefighting equipment and location of exits

7. How, when, and where to report injuries

8. Housekeeping and cleaning up spills

9. When and where to report unsafe conditions

10. Safe operation of powered equipment

11. Proper personal attire and required personal protective equipment

12. Special hazards of the job (review of material safety data sheets)

Consent

I reviewed the above checked items relating to the safety rules and safe work procedures, I have been given the opportunity to ask questions and I know that future questions can be directed to the nurse supervisor.

Employee Signature

Date

MM slash DD slash YYYY

Supervisor Signature

Date

MM slash DD slash YYYY

3901 National Drive Suite 220 | Burtonsville, MD 20866
Phone: (301) 970-9706
Email: carewannmd@gmail.com

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