Verification of Orientation in the Hazard Communication Program

Employee Name:  ___________________________________________

Department:  _______________________________________________

I certify that I have received written/verbal training (please circle the appropriate training method), which provided me with a basic orientation in Harford Community College’s Hazard Communication Program and that I am familiar with the following components of the program.

-        Federal and state regulations and laws require Harford Community College to establish, implement, and maintain a written Hazard Communication Program for the purpose of establishing safe workplace habits regarding chemical use and storage.

-        Employees are allowed access to the written Hazard Communication Program, the Chemical Information List, and the Material Safety Data Sheets; I have been informed of the location of this information.

-        All employees shall receive a level of training appropriate to their exposure and use of hazardous chemicals.

-        All employees have an obligation to participate in Hazard Communication Program training and to document this training.

-        An exchange of information will occur between Harford Community College and outside contractors if either party will be exposed to chemical hazards as a result of the contracted work.

-        All employees are required to follow the procedures established by the Hazard Communication Program, to include informing the safety officer if they bring hazardous chemicals onto the campus.

-        Procedures are in place for the handling of chemical spills and suspected chemical releases to the environment and each employee is informed of these procedures.

Employee signature:  _________________________________________________

Trainer/supervisor signature:  __________________________________________

Date:  _______________________________________________

All employees must have the supervisor’s signature.  The supervisor will provide the employee with a copy of this form and send copies to the Human Resources Office for inclusion with the Personnel File, and to the safety officer.