MRL New Participant Safety Training Documentation Form
***Please PRINT LEGIBLY and return this form to Sylvia Vogel in MRL 2066G when complete.***
Employee Name: ______________________________ Job Title: _____________________________________
Home Department __________________________ Your E-mail address _______________________________
UCSB Supervisor's Name: ________________________ Their Job Title: ________________________________
Check below for all topics reviewed:
_____ Employees of UCSB and of the MRL have specific rights and responsibilities. These are described and available
for review in the Campus Emergency Operations Plan (EOP) and Injury and Illness Prevention Plan (IIPP); and in
the MRL EOP and IIPP. The campus plans may be reviewed at
The MRL plans (not the same as campus plans) may be reviewed at
_____ The Department Safety Representative (DSR) is Joe Doyle (email@example.com; Rm. 2066F). The Alternate
DSRs are Maureen Evans (firstname.lastname@example.org; Rm. 2066E) for MRL, Sara Bard (email@example.com,
Rm. 3107) for MC-CAM, and Jennifer Ybarra (firstname.lastname@example.org, Rm. 3117B) for ICMR.
_____ In any emergency where there is injury to any person or threat to any structures, call 9-911 first and then notify
_____ Any time the building fire alarm sounds, all personnel in the building must evacuate the building immediately and
assemble at the southwest corner of Engineering II. This is the MRL's Emergency Assembly Point.