b'Protect Employees andComply with OSHA RequirementsEMPLOYEE & APPLICANT NOTICE ComplyRight Fill-and-Save HR Form Library:Drug-Free Workplace Poster OSHA & SafetyOur Company Is a Explains possible substance screening requirement Have easy, unlimited access for 12 months to the most DRUGFREE and the physical and legal dangers of drug abuse current OSHA forms along with a collection of other documents targeted to workplace safety. The OSHA & WORKPLACE Helps deter substance abusers from applying at your workplace Safety Form Library includes OSHA Forms 300, 300A Our Company is committed to maintaining a productive, drug-free workplace thatItem #Price and 301; Workplace Injury/Illness Reports; Fitness for keeps employees and customers safe from harm. For this reason, we may require applicants and employees to take screening tests for alcohol and illegal drug useDL2-W0248$29.95before hiring and during employment. Duty Certification and more. Forms can be routed and We expect all employees to comply with this drug-free workplace policy, to beLaminated. Size: 18" x 24" responsible for their actions, and to recognize and report any workplace dangers. completed electronically, and stored on any computer Dangers of Drug and Alcohol Abuse or printed for employee files.D - gbse ainndgoafl ceomhopll ocyaene sh, acvoew soerrikoeurssan edv ecnu sftaotaml er se fcfaenct bs.e T ehned ahnegaeltrhe dan bdy : E-Z Split Key Drug Testwerul Dependence or addiction Mreudgi-c aorleamlcoerhgoeln-ciniedsu ocer da cimcidpeanirtms reensut lting from d Fillable PDFs ensure forms are legible andChronic physical problems resulting from drug or alcohol abuse Increased risk of exposure to HIV, hepatitis and other diseases Tests for marijuana, cocaine, opiates, amphetamines and PCPSafety-Sensitive Industries easily routedUnder the Omnibus Trasintisvme einntd uvsethriicelse s,ibnucslu transport, railroad and massTotally self-contained, confidential drug testportation Employeed Tinesgt ainvgia tAioctn ,o mf 1o9t9o1r ,carriers, employers in safety-senvmerpnloyees for drug and alcohol use. 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Item #Price Substance abuse Unlimited downloads ensure forms never run outp2017 ComplyRight, Inc. www.complyright.com This product is designed to providegntcahcearctun airnantgye ypaoenrudsr o uprcni I re pu aua torhrtio cernuitltaaitrtiy vs iietn uivnaoftolivorenmd aa intni docn ran.e Hoayt isnwpgee, cvpierfrioc,diqtu uicsei nnstogio ton arssdu ountaonf yt hspe eucsiefi oc rf aicntasb o olri tsye rtvoi ucsese. t Thihse p irnofdorumcta. tYioonu i DL2-W0217 $38.95 affects employee safety W0248 asm p roorv rgtiaedndet dt no w octiotehn:sTtuhhletisau ninsdaateptropsrtrnaonevdyedi cn ofor use by the phaser only. This form may not be shared publicly or with third parties.oisrb tcsrotiibtnuuctteeir nfngosrty hloeiugs a pmlr aaodyd vuhicactev e ias. nndo dt loiaesb nleo fto rp raonvyid dea lmegaagle so pairnisioinngs Guaranteed compliancePrice each. 5-test minimum. and company productivity. Communicate your companysItem # Price commitment to a drug-freeDL2-A9004W$99 per yearworkplace and reinforceFill-and-Save itemthat message withdrug testing.Cal Forklift Safety BundleCPR Use common sense with any serious injury. l n of the victim. Avoid movingEnsure your company follows OSHA rules and makes911 (or other emergency number) for assistance right away. Know the type of injury and the exact locatio inufmoramna Rteiosno udroceessnDoetp taarktme tehnet , Forklift SafetypolcaacelRoefd C PCRro (sCsa orrd Aiompeurlimcaonn aHreya Rrte sAussscoictiaattiioonn).tTrhaeinsie instructions are for adults on d first aidin kiintgs ,a croen kteapctt. y Tohuirs Hiffer).the victim whenever possible; bring help to him/hern ign.s Ftoera de.m Kenrogwen wchy efirres tA aEiDds a anndly C (PinRf tarnat and children CPR dFollow these steps for adults and children over 8 years of age who have an obstrucoachway. e victim: appeoat prs to h 10 Steps to SafetyUse common sense with any serious injury. Cal 911 (or other emergency number) for as 1 Make sure it is safe tot Do n ut yaovue brseeelf in en dlaecngtreorc. Do nuted. oCt talol u9c1h t1 ihme vmiecdtim iiatef hlye. /sheComplyRight forklift safety a priority with this comprehensiveCHOKING and the exact location of the victim. Avoid moving the victim whenevera prdroiosps uolrm Amonearricya Rne Hsuesacritt aAtsociation. appred air th nAecre yk ionu ajuryll r. If there is no rictim, tap him/her gently and ask loudly, r Lifesaving Posters 1. Training B 2. Loading & Unloading 3. Batteriestraining compliance bundle.os istance right away. Knowo twh we thyepreeoAfE iDnsj uarnyd fi ible; bring help to himi/ohne)rtirnasitneinadgKFonr emergency first aidanrsdtCaPidRktirtasi narineg k,e cpotn. tTahcitsyinofuorr HmuamtiaonndRoeesos unrocte sta Dkeep tahretm pleancet,olof cCaPl RR e(Cd CIf its safe, appigrhota?c Do nh the vot seshpaokne tse ohe vr tihce vtim iicf ytim iou ss nuost bpecret a bathiancg ok or onlyseoccukrebdo abredf oorrebtrhiedyg eaprela dtersiv, eshna olvl bere,pwriotphe trhleyi r Determine Choking is recognizable when the vicving through the persontim CANNOs throaT brt. Aeaskthe, Ar, ce yough ou2 Observe the situationgasping for air, have a bmedyiasttealny pderr cocaeed tll 911o t, ohr ce nall yexot sutresepl. f iIf possiblef no bysta, placndere sCommunicate lifesaving techniquesThe emplo hasyer been shall CFRtrained 1910.178(1). and evaluatedinr apklaecse s thoa lplr beve esnettmanodv wemheeneltobflo tcrkusc kssh, atlrla bilee r s,D t atee dra cteadp accaiptyac niteyv eorfethxec eterudcekd . sOhanllly b leo hadasn dwleitdh.in& Fuel Tanks Includes laminated poster with 10 vital1 if the victimor talkno air is mo and attempt to wakea e prheosneen to, ann sd ipemaketion, and prr so the dispoavide help with pertcher can help youf corhming CPR. eck for breathing,operatorcertify that eachor raillorooardin cga rosfwtruhcilkes ,lo traadiilnegrs ,d a wndeakness befor rhbe used. F nnnoint gb ea nfidl lsepdi lwlahgiele s halchoking? If the victim can breathe, cough or speak, stand by, butthre p as requiredinclude the nameT or un lroaaildrionagd.carse When stacking or tiering, only enough backwardthuee le ntagninkessish aruldo not interfere. the victim: get your precise loca nce, you or The certification by 29 shallshhael lf abreecdhreivcekne do nfotor .breaks an tilt to stabilize the load shal be avoided.is choking: If t of the operator, the date of and thethetraining,theyTrucks in need of repairs to the a bhye vstainctdim rer meuspsot pndhs boneu t i91s i1. nRjeucred oheckr n theede vis mctimeds iccoal andsitsiiostna frequently. clearly while complying withthe dateofofthetheperson(s)evaluation, performingelectricalIf the victim is NOTStand behind the victim and wrap your arms around the personsidentity disconnec systemted prio shallr to s haucvhe r theepa ibatteryrs. procedures to help you avoid accidents 2 talking, coughing waist above the navel. Make a fist, with thumb side against theIf you do not suspectPlan u ace-upOSHAs General Duty Clause.the training or evaluation. Forklift Operators Daily Checklist 4. Routine Week Ending _____________________________ Checklist helps you identify possibleor breathing: stomach (above the waist and wour other handell below the br. eastbone), 3 a back or neck injury: If a ce tnhre vespicotnim osive vn a hictiam ird ss fuarcfae dce ion a fwn, raoclel t-uhp pe voicstiitm tiono a f. AlwaysPlease PrintChecksand grasp your fist with y position by placing one hand gently on the head and neck and the other on the hip, turning the victim as a unit. RememberReinforce your commitment to anot be permitted. before ______________________________3 Pull your fistUse quick uption is clearward and ined or the vicward thruststim bec. Repeaomes unct as necessaronsciousy, un. tilLcate tetwhe meen tidhde nle oipf tphlee bs. Prleaacse ttbhoe hne beey dl orf one hand just belowawing an imaginary safe business environment.Stunt driving and horseplay shall Hour Meter Reading:#_________#/ / IndustrialTruck # trucks placed shall in service service, oblem in the #) in the OK box. / / # ________ maintenance issues earlyForklift inspections must be completed daily at the beginning of each shift. If no prinbe examined and theshall notbeing oblems are found, place a check ( be placediftoward thethe obstruc lio Fire aisles, access shall tobestairw keptays, clear andIf the item does not pass inspection, place a check in the NEEDS MAINT. box and describe the pr of theComments section. # If this should happen, call 911 immediately. ne b fire equipment examination showstheany safety condition adversely affectingvictims stomach: that line and then place the heel of the second hand on top ofRunning over loose objects on the Date / / Date_________ vehicle. Such examination shall be madeDate________ Date _________ Date / /## If the victim Carefuly elany t thhee a viricwtaimyboynphliasc oinr gh eorn bea hcakn, pdr oonte tchtein vgic tthime hse foadre ahnedad4 Immediately beginthe first so the hands are overlappuedld. Sers atrarie ighn lten yine aoubr aovre m s, lockroadway surface shall be avoided. Place check in OK NEEDS T. MAINTENANCE OK MAIN MAINTENANCE atleast MAIN / / OK MAIN / / OK MAIN / / OK MAIN MAINTENANCE OK MAIN MAINTENANCE Includes informative forklift training video(Initials) (Initials) be Datedaily _________shallMAINTENANCENEEDS T. APPROVAL NEEDS T. APPROVAL . Defects whenDate _________immediately reported and foundcorrected.lbuor hws aandnd ls. Uesminag ttelyh e h2 ineechls oes but no mor (Initials) (Initials)eo an over so your sf bhooth hande than 2.4 inches on the s, firmly push straight APPROVAL APPROVAL (Initials)4 becomes n I n y tohuedaoirwnta sye. Iefyaonuyt sheineg a,n im obmsetrduiactteiolny ,a rtetaemchp int c ahnest cd takoem itp oreusts.i ons. chest compressions: y on p DescriptionItem #Price 10. Keepapplicable boxMAIN APPROVAL NEEDS T. APPROVALOKNEEDS T. MAINTENANCENEEDS T. MAINTENANCENEEDS T. APPROVAL(Initials) (Initials)down approxianedck t.h Oep otheinrhliaftn).d K uenepd etrh teh me ochuitnh a onpde ng.e Cnthlye ctkil tf othr eo bhsetarudc btaiocnkchest.w tuhse chehse, kst teeo rpineg yturn ou rA rakesParking 5. Traveling(head tilt-ch hands oRen tlehae vse picrteismsus cre cheosmt apt aletll tely bimeest. Aweel Bcceleratorto i rmal p ochsietsiotn c beotwmepelne tceoly ampftreer essioanch cs. Coomunprte thsseio nnu. mAvboeidrTrucks Clean BrakesService All traffic regulations shall be observed, unconscious: if leants ningo on the Industrial trucks shall be kept in a cleanHornplant speed limits. of compressions by saying one and two and three Push hardcondition, Hour Meter including authorized shall truck be maintained lengths from L I and push fast (rate of 100 to 120 compressions a minute). grease. Noncomb free ofustible lint, excess agents oil, should andHydraulic Contread and olsTail A safe distance three Evaluator Bundle Includes:approximatelyaftyao rua atere o nf 100 to 12 the truck ahead, and the truck shall be boectwateee tn the mhe nididplpe olesf t. Phle bace trehae hstbeeonl oe bf oy dne hrawainnd jg aun ist bmealgoiw tnarhy lat in eot trained0 i nco CmPRpr oers sairoen us nac mominfuorteta ubnltei lw ainth A yEoDu ar rarbivielist ya ntod p isr orevaiddey r feosrc uuese b,r tehaet vhisc, tsimkip b setgeipnss 5 t oa mndo v6e a onrd E cMoSn tpineruseo pnnereflo tramkein ogv cehre csatr ceo omf tphree svsiicotnims.be usedentsforwith cleaning flashpoints trucks. abo (Includesve 100 F.)LightsH FoForkrlkiflitf tO Oppereartaotro rE vEavlaulautaitoionn Evaluators Copys Copylne ahe hnd tanhdes an pre olace tvehrle happeeedl o. Sf ttrhae sighecteon ynd houar and ormsn t, loocp ok ef tlbhoe fiws r st Open the airway by placing one hand on the victims forehead andt Choking PosterDL2-W0324 $29.95 solv LightsWarning Please Print kept under control at all times. Evaluation D________________ LastLast Training DTraining Dateate ________________ ________________5 Begin chestsio t e than 2.4 inches on the chest.After 30 compressions hhee o s c CPR PosterDL2-W0328$29.95 9. BewareOverhead Guard Please PrintS S USUSIf the load being carried obstructs N /N Evaluation Dateate ________________S S USUS/ / Forklift Safety Poster Forklift Safety Training ProgramSteering forward view, the driver shall be and lean over so yf bouor sth hhoaunlddes, firs armre ily pn luinsh se atbroaivge yht douor hwn ands. ad tbhaecr hk (ahned uad ntidlte-cr thhine v lifitc mtimets chohdi)n a. Mnad gintaeinntinly tg tilht teh oe vpeinc taimirws ay,Tires Operator _____________________________________________________________ / / / /required to travel with the load trailing.Operators Ns Nameame_____________________________________________________________ compressions: Using the heels o on p ard 5 open the airway andgently pinch the victims nosse se a mhut aountd ch gouvaerr td ahe ms shoowutnh w. Giivth ye thoe urs,Laminated. Poster size: 18" x 24"of Ramps 8. AvoidOther WorWk Location The driver shall be required to look inM t ain Evaluator / / N/AN/A COCMOMEMNETNSTS Forklift Operators Forklift Operator approximately 2 inchepsl ebut no mortely betweelw thue cshehse, kst teeo rpineg yturn touo ir htas ndsvricetaim tting awo fn auilrl, stiglohw rt seeasl, ocur ue breaths. Each rescue breath should beWhen ascending or descending gradesGas, LPG, or Diesel Forklifts Only_______________________________________________________________Evaluators Ns Nameame _______________________________________________ork Location ______________________________________________________________________________________________________________thepath of of, tra andvel. keep a clear viewon t of the directionRelehae vse picrteimssus cre cheosmt apt aletell tlyi mafetes. Ar each compression. Avoid leaningdelivered in one second and should cause the chest to rise. MakeEngine Oil Level S =SS=a Staistfiascftaocrtyo r y USU=SU=n Usanstiastfiasfctaoctryo r y A /=AN= oNt oAt pAplipcalibcaleblenormal position com Fuel Level Inspecting the F N/AN/A COCMOMEMNETNSTS Properly operated ramps and inclinesocomopne aresnsid tonsw. o aConud tnt thhree e num Pbeur osh hfbegin rescue breathing: burere yatho. Thu tais pke a rrevegenuts ylar (ou fnot a drom geeept) bting dreatih bzzy oetr lweeighn etheaacdh rede. Wscuae tchin excess of 10 percent, theloadloaded upgrade. trucks Oil Leaks Inspecting the Forklift (Prorklift (Pre-Opere-Operation)ation) Properly operated ramps and inclinesds and unevds and uneven suren surfaces facesconm thper ecshseiostn bs bety sweaeyningth hest. If it does not clearly rise and fall after the firstshall Oil Pressure FolloFollowed operator daily checklist Checked for slip/trip/fall hazarand push fast (rate of 100 to 120 compressions a minute). On all be grades driven the with load and loadInspecting the Load 6. NeverbeforChecked for slip/trip/fall hazarI rese vcuiec tbimres ca trehs, cpueer fborrema tthh.e head tilt-chin lift again before givingengaging means and shall raised be only tilted as farbackPedestriansRadiator Water Level wed operator daily checklist Leave TruckMabefor ine to dismounting Daily ChecklistEvaluation Form Inspecting the Load ine to dismountingif applicable, Checked w eight distribution and stability of load teadin 3e-dp 3o-inpot icnotn ctoacnt awcht ewnh meno munotiungt/idngis/mdiosmunotuingtingElectric Forklifts Only Checked weight distribution and stability of load Load Handling/Stacking/Unstackingthe second Picking up a load Load Handling/Stacking/UnstackingPicking up a load ando 7ve a onrd E cMonS tpineruseo npnereflo tramkien ogv cehre csatr eco omf pthree svsiicotnims.Do not try more than two times to give a rescue breath that makes the chest rise, because it is important to continue chest compressions. as necessary to clear the road surface. Trucks shall not be driven up to anyoneBattery Connector ed personnel from the arom the area of the loadea of the load Unattended ClearCleared personnel fraftyao ura atere o nf o1t0 t0r atoin 1e2d0 i nco CmPRpr oers sairoen us nac mominfuotreta ubnleti wl ainth A yEoDu ar rarbivileist ya ntodpisro rveiaddey r feosrc uues eb, rtehaet hvsic,t sikmip b setgeipnss6to m ClearCleared personnel fr Made sur ed personnel from the arom the area near the loadea near the load7. Repairs &Made sure there there was sufficient clearance for the loadForFk positioningork positioningBattery Discharge Indicator Centered for e was sufficient clearance for the loadProper penetration into pallethhee o to Maintenance when the operator M seed for oeaklift to locationProper penetration into palletOpen the airway by plahce vingi cotnime s chohdi)n a. Mnad gintaeinnitnly tg itlht teh oe vpeinc taimirws ay,t fix stand wedLifted the load car A powered industrial is 25 truck ft.orisunattendedmore awayRaoiCenter v a o t e htlhd lotaklift to location o dt dhand on the victims forehead andstanding in front of a bench or otherOther Gauges and Instruments R de ed forthoe tphlea cpelmacenmt elnevte le avte la acto an ctronltlreodl lsepde espdeLifted the load carefully and smoothlyefully and smoothlyadt bhaecr hk (ahned uad ntidlte-cr thin lift met ed object. or pass Nounderperson the shall ele vbeated alloTilted the mast back to stabiliz di sved forwarward slod slowlywly6 After 30 compressions g ke sure you t. Thakis phreesvte. Inf ite a regulas yr (onu fot a drom got cl ) breath bizzy ond f r lailghtfhte ours,.6 After delivery of twoRepeat the combination of 30 chest compressions and two rescueprovided with the understanding that a d s in ergedid to u u g o ti n spa gal u isctportion of any truck, whether loadedChecked by (Initials) S Tilted the mast back to stabilize the loade the load from the vehicle which remains in view,P M / ver both shoulders before backing oute backing out u W1732 DescriptionItem #PriceComments Checked for clearance fr ve,or whenever the operator leaves thePositioned the load properly on the rackChecked for clearance from obstrom obstructionsuctionsIf at any time a powered industrial truckPositioned the load properly on the rackcreenattliy png ainn ach tirhtie vghit scteimals n, or uosse se a mhut aountd ch gouvaerr td ahs se mhoouwtnh w. Giivth ye thew not be permitted isfound Looked behind (o e raising/lo vehicle and it is not in his/her view. Looked o ks of pallet/rack beforLooked behind (over both shoulders)ver both shoulders) Looked over both shoulders beforv breaths, remembering to release all pressure bYoeut swheeoun pld ucosnhteis anuned t tho isor empty. Unauthorized to ridepersonnelon powered shallorin any to w beayunsafe,in needtheof repair truck,shalldefectiStopped forBacked up sloBacked up sloklift beforwlyklift beforwly e raising/lowering tineswering tines Stopped forklift beforklift before raising/loe raising/lowe raising/loering tineswe raising/loweringweringering tinesopen the airway andbiec tdim telivwero fedu ilnl, s olnow re seecsocune bd anreda tshhso. Euladc h rcauessec uthe be crehaetsh st toh oriuseld .rescue breaths: coamtcbhi nthaeti ocnhe osftcroisme panreds sfaioln dsu/brirnega tbhrse uanthtisl . an AED arives, the victimindustrial trucks. be taken out of service until it has beenWhenleftshall unattended, be fully lo wered,load eng controlsagingCleared fored forks of pallet/rack beforFtopped for ered to safe travel height beforel height before moe movingving Clearrestored Stopped for means Truck/T railer Loading/Unloading orFks lo Truck/Trailer Loading/Unloading orks lowerwed to safe travAll repairs toshallsafe operating be madeonlycondition. bySet brakesbegin rescue breathing: W t does n l a h begins to move or EMS personnel take over CPR. 2016Traveling with a load wer the load while travelingeling shall beneutralized, power shall be shutChocked wheels/jack stand in placerea cah dedeDid not raise or lo Set brakesMasctcuh te bhre veatichtims c eepeetatrinly rg dise a etween eaer t ComplyRight, Inc. Traveling with a load el off, andbrakes set. Chocked wheels/jack stand in placeDid not raise or lower the load while travauthorized personnel.first rescue breath, perform the head tilt-chin lift again before givingEMERGENCY INFORMATION: CPR VOLUNTEERS: Trh mis epdirocdaul acdt ivsi cdee asigndn eddo teospnorot vpidroev aidcet n loeyf gp athel roes oru nsm eoe odirr e cinnatlia tobyip liinintyvi ootolnv seu oHowever, it i sgs ur er bsuho titensintef lth a Looked in the dir Hut dockboar alpa rd/bridgeplates in place BundleBilingualDL2-W0873$349Kept legs and arms inside rection of travection of travunning linesunning linesel orH ala rsmou nsoduend teod i ntod icnadteic areteve resve mrseo mveomvenmtentLooked in the dir obranc/kbuacpk d/bridgeplates in placeKept legs and arms inside r Pnut dockboar mthe second rescue breath. an curate and authoritative information.saptineocifdgu,i cpct r.f Yaocodtsuucinaorreon tah ncrisy e pr o novt aice sss.tur iT bc tinformr laettritooodnr neySounded horn at intersections and pedestrians Work Platforms oved platforms for elevating personnelating personnelSounded horn at intersections and pedestrians Work PlatformsDo not try more than two times to give a rescue breath that makes the chest rise, because it is important to continue chest compressions. 911OR Name: _______________________ Phone:________________________________ is not liable for aplnyro .a fAlelosnsy other photocopyingmparticular situation and any specific questions or concerns you may have. Daily Inspection Checklist Yielded to pedestrians Used only appr w passengers on platform while travelingelingAmbulance:__________________________________________________ co y dawmioeandg aeinls caotrhniescin inergns tinoruugc ytioourn os,rCreopmropdlyRuciigngh itn p raondy ufcotsrm m, wayh ebteh eprh iont owchopolieed o ro ninly p awrht,e insstthrei cutlsye rp rios hleibgiatlelyd .Yielded to pedestrians Used only approved platforms for elevUnd/olepsesrllsmepdee cifdito cidcaaol l so Maintained a safe speed SecurSecured the platformMaintained a safe speed ed the platformObserved all traffic rules, warning signs,Did not alloved all traffic r erhead clearances Did not allow passengers on platform while travR Local Emergency Phone #:______________________________________ Name: _______________________ Phone:________________________________ W0328 It is imperative that a safety check be performed before each shift to ensure safe operation.Oil Leaks S Obserfloor load limits, and o S A verhead clearancesFor More Information, PleaseF Fueling and Battery Rechar F E e reyc hraecrghianrg ipnrgo pceroduceredsures Forklift Safety PosterDL2-W0048$29.95Check for any defects in the items below before duty: floor load limits, and ovules, warning signs,Fueling and Battery Rechargingging7 After delivery of twowatch the chest rise and fal ns and two rescnud teoCPR Kit Location:______________________________________________ Name: _______________________ Phone:________________________________Accelerator Fuel LevelHydraulic Controls Oil Pressure FolloAllo ed other vehicles at a safe distance Name Turned engine off Forklift Safety VideoEnglishDL2-W0722$329wed other v urned engine offAllo Fwollo ehicles at a safe distance WorTWe apprwwed no passengersed no passengers ore appropriate PPopriate PPEbreepaetaht ts, rhee cmoemmbbienriantg tion oo rf 3ele0 case ahesll pt coremsspurree bssioetween pushes a 2015 EDIwww.complyright.com Batery Connector Enilg Lineev el Overhead Guard Steering wlopplied brakes and stopped smoothly Contact: lowooked up charger prBatery O Radiator Level ed do wn when changing directionsections Hoooked up charger prwed down when changing dir lH leodw pedro perorp fuere lfiunegoperlyl iangoperlyd a bndat tbearytAlopplied brakes and stopped smoothlyrescue breaths:during breaths. You should continue thisDischarge Indicator GaugesLightsUnusualTravTeled with for OverOverall Evaluationground surfacefaceks at a prks at a proper distance abooper distance abovevecombination of compressions/breaths until an AED arives, the victimBrakesParking HornHead and TailNoises raveled with for all Evaluationground surbegins to move or EMS personnel take over CPR.BrakesServiceHour MeterLightsWarningTires Recommendations/Comments: ___________________________________________________________________________________________________________________Recommendations/Comments: ___________________________________________________________________________________________________________________Telephone__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________EMERGENCY INFORMATION: CPR VOLUNTEERS:Phone:________________________________ Trrh oimsv iepddreiodcd awul ciatdth vi sit chdeeesauingndnd ededros ettaosnpndroiotnv pgi rdtoheva aitcd aecnu leyrag ptaeelroasnor dnmaoeurd teihcnoatlrii totyap tiinivnveio oinnlvsfe odorn min aa nctyiroepro p U i a o dm p sp.nH cgu i o fwever, iti nirs gserrgvtde ,i c cp naies sttr.o iTb cuhoensult an at ald nuiscet y I Tm u cls t yto itofu trht weefiuothsr e tle hogirra dli n apadbavrilticiieety s a.tnod u dseo tesh niso pt rpordouvcitd. eY loeug aal roe puirngieond st oo nc oannsyu slpt eanc ifaitct ofarcntesy o cro snecrevricniensg.Tyhoeu rin pfaorrtmicautiloarn s iist upartoiovind aendd w aitnhy t shpee ucinfidce qrusteasntidoinngsothr acto nanceyr pnesr ysoounmora eyn htiatyv e. 2016 ComplyRight, Inc.2016 ComplyRight, Inc. __ _ __ _ ____ 48 _ ____ ____ ______________ Checklist form: 50/pkg. Evaluation form: 25/pkg. 2-part carbonless, valuators Ss Signaturignature _e_ ______ Date/ /EvEaluator ________________ _________________________________ _______________ _____ ____ _ Date ______________s not liable for any damages arising out of the use or inability to use this at eindt .r fYaoodctuuscoare uooricdsubstitti uintngef o tfhormrislaeptgritooorn / / W0300911OR Name: _______________________ cnorlsedeedc tiofic idacalo lp lsyor o.a fAleosnswyie oodnt hainlecrto hpnehc oientrsontcriounpcgyt iyionongu sro,rpC aroermtpircpoulydluRarcig isnhittgupianrt oioadnnuy ac ftnsodr m maan,y wybshepe pethchieofric tion cq owupehiseotidloenoonsrloyinr wcphoaenrntc ,e tisrhne s stur ysicoetrulyim sp laeroyga hhlialbyvit ee.d.inhvpiosol vprretadond itunnccto rtieesa :d This istiensgig, pnero dad ptuopc rpoinrvoge vdoir df eod ria scutcrseuibr bauytti etn hagnedtph uiarcsu pthhraoosdreiurt acotti nvisley.ni oTnftho lirisam bfolaetrmi foo nrm. a Hoanyy w ndoeatv mbeera, g sihets ia sar ernidos itpn aug bs oibul 2016 ComplyRight, Inc. W0 W0300Ambulance:__________________________________________________ onml/epses lLocal Emergency Phone #:______________________________________ Name: _______________________ Phone:________________________________ 11" x 8". Laminated poster: 18" x 24"CPR Kit Location:______________________________________________ Name: _______________________ Phone:________________________________2015 EDIwww.complyright.comW032460 EMPLOYER COMPLIANCEOSHA & SAFETY HRDIRECT.COM800.999.9111 61'