"Restaurant Employee Safety Orientation Checklist Template"

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Restaurant Employee Safety Orientation Checklist
Restaurant Employee Safety Orientation Checklist
Instructions: Each employee will receive a safety orientation before beginning work. Please check
Instructions: Each employee will receive a safety orientation before beginning work. Please check
each item that was covered in the orientation. Employees will sign this form once all items have
each item that was covered in the orientation. Employees will sign this form once all items have
been covered and all questions have been answered satisfactorily.
been covered and all questions have been answered satisfactorily.
The employee (name)_______________________________________________________ has been:
Informed about the elements of the written safety program that outlines the company’s safety efforts.
Informed about monthly crew safety meetings.
Told to report all injuries and shown how to do this.
Told to report all hazards to her/his supervisor and shown how to do this.
Informed about all machinery hazards and if < 18 years of age, instructed about prohibited duties.
Informed about all other hazards and ways to protect themselves (i.e., chemicals, use of ladders,
slippery floors, etc.)
Shown where the first aid supplies are located and who to call for first aid.
Told what to do during any emergencies that could be expected to occur.
Shown how to operate a fire extinguisher.
Informed of and trained on chemical hazards according to the Hazardous Chemical Communication
Program training requirements including how to read a label and precautions to take when using them.
Trained on the safe methods to perform the specific job the employee was assigned including any
hazards associated with that job.
Initial job assignment: ____________________________________________________________
Provided any formal training required to do his/her job, such as proper lifting, use of knives, grill and fryer
operation, spill clean-up etc.
Initial formal training given: ________________________________________________________
The signatures below document that the above orientation was completed on the date listed. Both parties
The signatures below document that the above orientation was completed on the date listed.
accept responsibility for maintaining a safe and healthful work environment.
Both parties accept responsibility for maintaining a safe and healthful work environment.
Date: ______________ Supervisor: ________________________________________________
Date: ______________
Supervisor: ________________________________________________
Date: _______________Employee : _________________________________________________
Date: _______________
Employee: _________________________________________________
Revised: 03/18/02
PUBLICATION F700-140-000 [03-2008]
Restaurant Employee Safety Orientation Checklist
Restaurant Employee Safety Orientation Checklist
Instructions: Each employee will receive a safety orientation before beginning work. Please check
Instructions: Each employee will receive a safety orientation before beginning work. Please check
each item that was covered in the orientation. Employees will sign this form once all items have
each item that was covered in the orientation. Employees will sign this form once all items have
been covered and all questions have been answered satisfactorily.
been covered and all questions have been answered satisfactorily.
The employee (name)_______________________________________________________ has been:
Informed about the elements of the written safety program that outlines the company’s safety efforts.
Informed about monthly crew safety meetings.
Told to report all injuries and shown how to do this.
Told to report all hazards to her/his supervisor and shown how to do this.
Informed about all machinery hazards and if < 18 years of age, instructed about prohibited duties.
Informed about all other hazards and ways to protect themselves (i.e., chemicals, use of ladders,
slippery floors, etc.)
Shown where the first aid supplies are located and who to call for first aid.
Told what to do during any emergencies that could be expected to occur.
Shown how to operate a fire extinguisher.
Informed of and trained on chemical hazards according to the Hazardous Chemical Communication
Program training requirements including how to read a label and precautions to take when using them.
Trained on the safe methods to perform the specific job the employee was assigned including any
hazards associated with that job.
Initial job assignment: ____________________________________________________________
Provided any formal training required to do his/her job, such as proper lifting, use of knives, grill and fryer
operation, spill clean-up etc.
Initial formal training given: ________________________________________________________
The signatures below document that the above orientation was completed on the date listed. Both parties
The signatures below document that the above orientation was completed on the date listed.
accept responsibility for maintaining a safe and healthful work environment.
Both parties accept responsibility for maintaining a safe and healthful work environment.
Date: ______________ Supervisor: ________________________________________________
Date: ______________
Supervisor: ________________________________________________
Date: _______________Employee : _________________________________________________
Date: _______________
Employee: _________________________________________________
Revised: 03/18/02
PUBLICATION F700-140-000 [03-2008]