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Page 1 of 2
Date:______________ Department:_______________________________

 Supervisor/Instructor:_________________________________________
Safety Training Topic:__________________________________________
  
  
  Training: Read and discuss the Toolbox Training chosen for this months Safety meeting along with the department employees. If provided, discuss the questions or discussion topics together as group. Use the material to verify your responses.
  Discussion: Have you had an incident/accident or near miss in your department in the past month? If so provide pertinent training, discuss, and list how a reoccurrence can be avoided in the future.
____________________________________________________________________

____________________________________________________________________

____________________________________________________________________ 
 
Discuss and list any Health, Safety & Wellness issues in your department and the plan to mitigate them:
____________________________________________________________________

____________________________________________________________________

____________________________________________________________________ 
 
 Discuss and list any Health, Safety & Wellness suggestions for the Safety Committee:

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

 List any departmental Health, Safety & Wellness needs the Safety Committee might help with financially:
_________________________________________________________________

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