WORKABILITY 1 PROGRAM - slosipe.org

WORKABILITY 1 PROGRAM

The WorkAbility 1 Program is coordinated by SELPA for school districts of San Luis
Obispo County. It is designed for special students to earn wages while gaining practical
work experience.

These student workers are, in essence, employees and are covered under the Labor Code,
whether it be the child labor laws or the occupational health and safety laws (California
Government Code, Title 8). Compliance with these codes is mandatory, not
discretionary. The SIPE Safety Coordinator, the SELPA WorkAbility Coordinator, or the
WorkAbility 1 Job Placement Specialist will review and evaluate the worksite
information. This evaluation does not preclude an on-site visit if requested by any of the
above persons. All applicable training required under Title 8 must be accomplished prior
to the participant’s first day on the job. For this reason, the following information must be
provided prior to placement.

JOB DESCRIPTION INFORMATION

Student Information:

Name of Student:

Age: _______ Grade Level: _________

School District:

Job Placement Specialist Information

Job Placement Specialist: ____________________________ Phone:

Work Site Information:

Name of Business: _____________________________ Phone:

Job Site Supervisor: ____________________________ Phone:

Department (or area) where
participant will be assigned
(if applicable):

Start Date or
Approximate Start Date:

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JOB DESCRIPTION SURVEY

To be complete by the Employer or worksite Supervisor:

Please check the box(es) which apply to work in which the student will be engaged. If none apply, list the appropriate
information in “Other Work” or in the “Comments” section below:

Handling Hazardous Materials Vehicle Operation
Pesticides spraying Automobiles/trucks
Pool chemicals Tractors (specify size)
Paints/thinners Forklifts
Glues Riding lawnmowers
Gasoline dispensing Golf carts
Body shop chemicals (resins, lead, paint)
Cleaning chemicals (dry cleaning/custodial) Electrical (use/installation)
Welding (welding rod) Arc welder
Radiation (medical x-ray lab) Electronic equipment
Cleaning chemicals (dry cleaning/custodial) Lighting fixtures
Welding (welding rod) Appliances
Radiation (medical x-ray lab)
Hazardous Work Placements
Equipment Operation Roadway
Power Saws (including saw chains) Ladders
Drill press Scaffolding
Lathe Roofing
Sanders/grinders Radiator shops
Lawn mowers/edgers/blowers Machine shops
Auto repair shops
Routine or Repetitive Work Auto body shops
Heavy lifting (over 25 lbs.)
Climbing ladders or scaffolding Other:
Reaching overhead (e.g., stocking shelves)
Repetitive motion (e.g., assembly line) Comments:

General Description of Job Duties:

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Note No. 1:
All personal protection equipment training and employee-right-to-know safety
training, and any other pertinent safety training requirements shall be fulfilled prior
to the participant’s first day of work. General Industry Safety Order 5194.

Note No. 2:
The work site employer shall have proof of an active illness and injury prevention
program. General Industry Safety Order 3203.

Note No. 3:
Only program participants 18 years or older may operate vehicles and only after they
have been trained in defensive driving training, such as that offered by the County
Superintendent of Schools. The participant’s driving record must be clear of moving
violation citations.

Note No. 4:
No participant shall operate an industrial tractor or tow motor without receiving the
OSHA-required training course.

Student Safety Handbook:

Prior to beginning work in this program, the participants shall be given the Student Safety
Handbook to be reviewed with them by their job placement specialist.

The Job Placement Specialist will certify that he/she has reviewed safety rules with the participants
and that the participants will attest to this by signing the acknowledgement page (last page) in the
Student Safety Handbook.

Certification
I certify that I have reviewed the Student Safety Handbook with this program participant and
he/she has signed the acknowledgement page of the booklet. I further certify that the program
participant has received applicable safety training for the work he/she will be performing.

Date: ___________________________

Job Placement Specialist

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