COUNTY HUMAN RESOURCES CHECKLIST
Employee name: _______________________________________________________________
Position: ___________________________________ Date hired: ________________________
Check one: New employee ⃝ Rehire ⃝ Part-time ⃝ Seasonal ⃝
The following documents should be reviewed with supervisor or made available to all employees. Check off to verify this has been accomplished. Employee and supervisor should sign this form.
⃝ County Personnel Policy : Explain leave policies.
⃝ County Group Benefit Plan
⃝ County Wellness Program
⃝ County Employee Safety Manual
⃝ Labor Workplace Hazard Notification Form
⃝ Safety Orientation Form
⃝ Immunization verification: Meet with county health department to review immunization status. Employees will be informed of recommended adult vaccinations. Waivers will be available if desired.
⃝ Payroll forms provided by and returned to the Finance Department
Employee printed name: _______________________________________________________
Signature: ___________________________________________________________________
Date: _______________________________________________________________________
Supervisor signature: ________________________________________________
COUNTY SAFETY ORIENTATION FORM
Employee name: _______________________________________________________________
Position: ___________________________________ Date hired: ________________________
Check one: New employee ⃝ Rehire ⃝ Part-time ⃝ Seasonal ⃝
Circle completed items:
· Orientation
· Accident reporting procedures (Appendix A)
· Tour of facilities and equipment
· First aid
1. How to obtain treatment
2. Location of first aid boxes at the facility
3. Location and names of trained first aiders
· Potential hazards of the job
1. What they are (Programs where applicable: HazCom, bloodborne pathogens, lockout/tagout, work station ergonomics, vehicle fleet safety and loss control).
2. How to use equipment safely.
3. Care and use of personal protective equipment
· What to do in the event of emergencies
1. Exit locations, evacuation routes and rally point
2. Fire alarm and use of firefighting equipment
3. Specific procedures (medical, chemical, fire, etc.)
4. Emergency intercom warning
· The total safety program
1. Function of Health and Safety Committee
2. Introduction to the Safety Coordinator
3. Health and Safety Policies and Procedures
· Personal work habits
1. Proper lifting techniques
2. Horseplay, good housekeeping
3. Safe work procedure
4. No smoking policy
· Group health plan coverage - wellness benefits
· Health, safety and wellness program
We have discussed the items circled above. I will consciously try to perform my assigned duties safely.
Employee printed name: _______________________________________________________
Signature: ___________________________________________________________________
Date: _______________________________________________________________________
Supervisor/safety coordinator signature: __________________________________________
Date: _______________________________________________________________________
COUNTY LABOR WORKPLACE HAZARD NOTIFICATION
County wants to ensure your work experience with us is safe and satisfactory for both employee and employer. The following is a list of potential hazards you may encounter while working at our facility. Please take time to read this list and ASK ANY QUESTIONS you may have about the list or the facility. Sign the form when you are done. If you have difficulty reading or do not understand anything on this list, please let us know and we will help you through the list.
Moving Equipment
· Watch for moving equipment including customer traffic and waste transfer equipment.
· Make eye contact with the driver before going near this type of equipment.
· Do not walk under or near a raised load (loader bucket or truck tipping).
Possible Contaminants in the Waste Stream
Do not touch any material which may be hazardous. Contact your supervisor before handling the following:
· Ammunition
· Containers with harmful liquids (Clorox, pesticides, Drano, acids, etc.)
· Containers with flammable liquids (gasoline, paint thinner, etc.)
· Potential medical waste, which may contain bloodborne pathogen
Slips and Falls
· Watch where you walk; the area may contain glass, wire or other materials.
· Surfaces and slopes may be uneven or covered with mush, snow or ice.
· Do not climb on equipment or jump off steps, docks, etc.
· Metal or rubber box flaps are slippery, especially when wet. Use caution on these surfaces.
Lifting Objects
· Do not lift an item if it’s too heavy or awkward.
· Get help from a co-worker.
· Make sure you have proper footing and balance.
· Lift with your legs, not your back.
· Do not twist when lifting.
Emergency Action Plan
· Report accidents, spills, leaks, fires, injuries, etc. immediately to your supervisor or the County Sheriff’s Dispatch.
· Know evacuation route and rally point in the event of an emergency.
Hazard Communication
· Many containers are labeled with contents and health hazards. Follow all warnings.
· Safety Data Sheets (SDS) are available to affected county employees.
· ASK if you have any questions before handling any chemicals.
Lockout/Tagout-Confined Spaces
· Do not remove any lockout/tagout device if you did not install it.
· Do not enter any area labeled confined space or asbestos hazard.
· Do not reach into any area or place where you may get caught in machinery.
Personal Protective Equipment
· Wear all required personal protective equipment provided for the job that you are given.
Employee printed name: _______________________________________________________
Signature: ___________________________________________________________________
Date: _______________________________________________________________________
Employee General Safety Rules
(Page 13 Employee Safety Manual)
• Seek medical attention, if necessary, for any incident resulting in an injury. All incidents must be reported to the supervisor as soon as possible.
• Report unsafe conditions, procedures and practices to your supervisor immediately.
• Possession of firearms on County property or in county vehicles is prohibited unless part of the employee’s job description or permitted by the commissioners.
• The use or possession of alcohol, illegal drugs or other controlled substances on the job is prohibited.
• Smoking is permitted in designated areas only.
• Each employee is responsible for good housekeeping by keeping his/her work area in a clean, uncluttered state. Do not walk by a situation of poor housekeeping if it can be easily corrected or needs immediate attention such as spills on floors or ice on steps. Call the Facilities Department if the situation requires its attention.
• Obey all warning tags and signs. They are there because hazards exist.
• Do not take chances on the job which could endanger your personal safety and health or the safety and health of co-workers or others.
• Do not operate machinery or use tools you are not qualified to use.
• Do not enter hazardous areas you are not authorized to enter.
• Use all personal protective equipment and devices required and provided.
• If an established job procedure must be deviated from, supervisory approval needs to be obtained and an alternative, temporary job procedure must be agreed upon. This alternative job procedure should not create any new or additional hazards or unnecessarily expose employees to hazards.
• Become familiar with and conduct your work activities in accordance with these general safety rules and other specific safe operating procedures which are applicable.
• Refrain from fighting, horseplay or distracting fellow workers.
• Follow proper lifting procedures at all times.
• Wearing of safety restraints when riding/driving a county vehicle is mandatory if so equipped.
• Know the location of fire/safety exits and evacuation procedures.
• Participate in safety training.
• When operating county vehicles or equipment, drivers must operate/drive safely and prudently.
• When using cell phones in a county vehicle, pull over and stop on the side of the road for calls or texting or use a hands-free device when possible.
• Above all, be ALERT and be RESPONSIBLE! Your safety and health depend on it.
Employee name: _______________________________________________________________
Position: ___________________________________ Date hired: ________________________
Check one: New employee ⃝ Rehire ⃝ Part-time ⃝ Seasonal ⃝
The following documents should be reviewed with supervisor or made available to all employees. Check off to verify this has been accomplished. Employee and supervisor should sign this form.
⃝ County Personnel Policy : Explain leave policies.
⃝ County Group Benefit Plan
⃝ County Wellness Program
⃝ County Employee Safety Manual
⃝ Labor Workplace Hazard Notification Form
⃝ Safety Orientation Form
⃝ Immunization verification: Meet with county health department to review immunization status. Employees will be informed of recommended adult vaccinations. Waivers will be available if desired.
⃝ Payroll forms provided by and returned to the Finance Department
Employee printed name: _______________________________________________________
Signature: ___________________________________________________________________
Date: _______________________________________________________________________
Supervisor signature: ________________________________________________
COUNTY SAFETY ORIENTATION FORM
Employee name: _______________________________________________________________
Position: ___________________________________ Date hired: ________________________
Check one: New employee ⃝ Rehire ⃝ Part-time ⃝ Seasonal ⃝
Circle completed items:
· Orientation
· Accident reporting procedures (Appendix A)
· Tour of facilities and equipment
· First aid
1. How to obtain treatment
2. Location of first aid boxes at the facility
3. Location and names of trained first aiders
· Potential hazards of the job
1. What they are (Programs where applicable: HazCom, bloodborne pathogens, lockout/tagout, work station ergonomics, vehicle fleet safety and loss control).
2. How to use equipment safely.
3. Care and use of personal protective equipment
· What to do in the event of emergencies
1. Exit locations, evacuation routes and rally point
2. Fire alarm and use of firefighting equipment
3. Specific procedures (medical, chemical, fire, etc.)
4. Emergency intercom warning
· The total safety program
1. Function of Health and Safety Committee
2. Introduction to the Safety Coordinator
3. Health and Safety Policies and Procedures
· Personal work habits
1. Proper lifting techniques
2. Horseplay, good housekeeping
3. Safe work procedure
4. No smoking policy
· Group health plan coverage - wellness benefits
· Health, safety and wellness program
We have discussed the items circled above. I will consciously try to perform my assigned duties safely.
Employee printed name: _______________________________________________________
Signature: ___________________________________________________________________
Date: _______________________________________________________________________
Supervisor/safety coordinator signature: __________________________________________
Date: _______________________________________________________________________
COUNTY LABOR WORKPLACE HAZARD NOTIFICATION
County wants to ensure your work experience with us is safe and satisfactory for both employee and employer. The following is a list of potential hazards you may encounter while working at our facility. Please take time to read this list and ASK ANY QUESTIONS you may have about the list or the facility. Sign the form when you are done. If you have difficulty reading or do not understand anything on this list, please let us know and we will help you through the list.
Moving Equipment
· Watch for moving equipment including customer traffic and waste transfer equipment.
· Make eye contact with the driver before going near this type of equipment.
· Do not walk under or near a raised load (loader bucket or truck tipping).
Possible Contaminants in the Waste Stream
Do not touch any material which may be hazardous. Contact your supervisor before handling the following:
· Ammunition
· Containers with harmful liquids (Clorox, pesticides, Drano, acids, etc.)
· Containers with flammable liquids (gasoline, paint thinner, etc.)
· Potential medical waste, which may contain bloodborne pathogen
Slips and Falls
· Watch where you walk; the area may contain glass, wire or other materials.
· Surfaces and slopes may be uneven or covered with mush, snow or ice.
· Do not climb on equipment or jump off steps, docks, etc.
· Metal or rubber box flaps are slippery, especially when wet. Use caution on these surfaces.
Lifting Objects
· Do not lift an item if it’s too heavy or awkward.
· Get help from a co-worker.
· Make sure you have proper footing and balance.
· Lift with your legs, not your back.
· Do not twist when lifting.
Emergency Action Plan
· Report accidents, spills, leaks, fires, injuries, etc. immediately to your supervisor or the County Sheriff’s Dispatch.
· Know evacuation route and rally point in the event of an emergency.
Hazard Communication
· Many containers are labeled with contents and health hazards. Follow all warnings.
· Safety Data Sheets (SDS) are available to affected county employees.
· ASK if you have any questions before handling any chemicals.
Lockout/Tagout-Confined Spaces
· Do not remove any lockout/tagout device if you did not install it.
· Do not enter any area labeled confined space or asbestos hazard.
· Do not reach into any area or place where you may get caught in machinery.
Personal Protective Equipment
· Wear all required personal protective equipment provided for the job that you are given.
Employee printed name: _______________________________________________________
Signature: ___________________________________________________________________
Date: _______________________________________________________________________
Employee General Safety Rules
(Page 13 Employee Safety Manual)
• Seek medical attention, if necessary, for any incident resulting in an injury. All incidents must be reported to the supervisor as soon as possible.
• Report unsafe conditions, procedures and practices to your supervisor immediately.
• Possession of firearms on County property or in county vehicles is prohibited unless part of the employee’s job description or permitted by the commissioners.
• The use or possession of alcohol, illegal drugs or other controlled substances on the job is prohibited.
• Smoking is permitted in designated areas only.
• Each employee is responsible for good housekeeping by keeping his/her work area in a clean, uncluttered state. Do not walk by a situation of poor housekeeping if it can be easily corrected or needs immediate attention such as spills on floors or ice on steps. Call the Facilities Department if the situation requires its attention.
• Obey all warning tags and signs. They are there because hazards exist.
• Do not take chances on the job which could endanger your personal safety and health or the safety and health of co-workers or others.
• Do not operate machinery or use tools you are not qualified to use.
• Do not enter hazardous areas you are not authorized to enter.
• Use all personal protective equipment and devices required and provided.
• If an established job procedure must be deviated from, supervisory approval needs to be obtained and an alternative, temporary job procedure must be agreed upon. This alternative job procedure should not create any new or additional hazards or unnecessarily expose employees to hazards.
• Become familiar with and conduct your work activities in accordance with these general safety rules and other specific safe operating procedures which are applicable.
• Refrain from fighting, horseplay or distracting fellow workers.
• Follow proper lifting procedures at all times.
• Wearing of safety restraints when riding/driving a county vehicle is mandatory if so equipped.
• Know the location of fire/safety exits and evacuation procedures.
• Participate in safety training.
• When operating county vehicles or equipment, drivers must operate/drive safely and prudently.
• When using cell phones in a county vehicle, pull over and stop on the side of the road for calls or texting or use a hands-free device when possible.
• Above all, be ALERT and be RESPONSIBLE! Your safety and health depend on it.
