This checklist is to be retained on record by the employee's mentor and the SULI Program Administrator, Farah Rahbar.  Form needs to be completed and submitted by end of the first week of work.

 

	Item	Enter Date Complete
	Read Environment, Safety, and Health Values and Expectations at SLAC (just the 1 page summary)
	Familiarize yourself with the Integrated Safety Management System, focusing on the five core functions (just the 1 page summary)
	Complete EOESH training. Study Guide is here:   Employee Orientation to ESH (EOESH)
	Complete GERT training. Study Guide is here:  General Employee Radiological Training Study Guide
	Read “Traffic Control Program.” (just the 1 page summary)
	Complete & sign your Job Hazard Analysis and Mitigation, along with your supervisor.
	Attend General Electrical Safety - Course 239
	Sign “Personal Commitment to Safety at SLAC” form below

I have completed the reviews of safety related material, workplace evaluations, Job Hazard Analysis and Mitigation form and my required training. I have read the SLAC Safety Values. I commit to follow those safety requirements that apply to my work and to behave consistently with the value SLAC places on my safety and the safety of others.

I acknowledge that I am responsible for my own safety and will perform my work in a safe manner. I recognize I have the right to refuse to perform any work that I reasonably believe to be unsafe.

Finally, I commit to contributing to my work colleagues’ safety by respectfully calling to their attention any unsafe practices I may observe. I also agree that if a colleague points out any unsafe practice of mine, that I will listen to the input and, in good faith, will reassess what I am doing.