Safety Comes First ChecklistSULI Students
Please attach all completed forms to this checklist. Submit signed checklist and forms to your SLAC mentor and the SULI Program Administrator, Vivian Lee within your first two weeks. Students require direct supervision of yellow work prior to completing WPC training & an ATA, at a minimum.
Top of Form
Item / Date CompleteSafety
/ Familiarize yourself with the SLAC ES&HPolicy
/ Familiarize yourself with the five core functions of Integrated Safety and Environmental Management.
/ Discuss with your mentorand familiarize yourself with the work planning and control process, including how work is authorized and released.
/ Students who perform yellow work (see WPC above), complete, signandhave your mentor sign an Activity & Training Authorization (ATA).
/ Read andsign “SLAC Motorized Vehicle Driving Privilege Form.”Return a copy to Security.
Training
/ CompleteSafety Orientation for Non-SLAC Employees (SON). (course 396)
/ CompleteGeneral Electrical Safety(course 239).
/ CompleteGeneral Employee Radiological Training(course 115).
/ CompleteWork Planning & Control training (course 120).
Commitment to Safety
I have completed the reviews of safety related material,including applicable Area Hazard Analyses, and required ES&Htraining. IfI have anActivity & Training Authorization,I will adhere to it in the course of my work. I have read the SLACES&H Policy. 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, reassess what I am doing.
Student’s Name: ______Date: ______
Student’s Signature: ______