b'Payroll FormsPayroll Change Notice Payroll/Status Change Notice BestsellerWorkplace PostersPayroll/Status Change NoticePlease PrintPayroll//I.D. # ___________________Social Security # ____________________________ Please PrintPayroll___________________ ___________________Separation Brought to you by ComplyRightDate _____________________Routing______________________________________ Routing Name _______________________________ Title ___________________________ Classification Separation //Effective Date of Change _____________New Hire Change___________________ Effective Date of Change _____________New Hire Change Employee Name_____________________________________________________________________________________________ Employee Name_____________________________________________________________________________________________Street Address _______________________________________________________________________________ LastFirstMiddleLastFirstMiddleSocial Security # _____________________________Employee/Payroll # ____________Dept. _____________________________ Social Security # _____________________________Employee/Payroll # ____________Dept. _____________________________City/State/ZIP __________________________________________________Phone (State) _______________ Payroll/Status Change Notice Street CityStateZIP Code What It Is: Division _________________________Department _____________________Shift ________________________Address____________________________________________________________________________________________________ Address____________________________________________________________________________________________________StreetCityZIP CodeTelephone #_______________________________ Date of Birth (for administrative use only) __________________/ / Payroll/Status Change Notice Date of Birth (for administrative use only) __________________/ /() ()Check appropriate box: Please Print Telephone #_______________________________Status:Full-TimePart-TimeFull-Time TemporaryPart-Time TemporaryOther______________________Routing PayrollStatus:Full-Time___________________ Part-Time TemporaryOther______________________ ___________________Part-TimeFull-Time TemporaryAEnter on PayrollFrom Transfer to:(Department) _______________________________ Please PrintPayrollLast/ J ob ___________________New HireCity ExemptMiddleNon-Exempt HourlyW-4 Attached? Yes No Help businesses meet Occupational Safety and Health Act (OSHA) requirements Job Title _______________________________ Exempt Non-Exempt HourlyW-4 Attached? Yes NoTitle_______________________________Change SeparationRouting/Effective Date of Change _____________ ___________________Change Rate //New Hire Change SeparationChange(s) for Current EmployeeChange Shift to: __________________________________________ Employee Name_____________________________________________________________________________________________Change(s) for Current EmployeeEffective Date of Change _____________ First TypeToComments Employee Name_____________________________________________________________________________________________Remove from Payroll Change Withholding Rate(complete new W-4 form) Social Security # _____________________________ FirstFromMiddle To CommentsType ddress Change _____________________________________________________________________________________________ Last Address ChangeEmployee/Payroll # ____________Dept. _____________________________DFLSA ReclassificationFull-Time Change Title to: ______________________________________ Social Security # _____________________________ D emotionE Employee/Payroll # ____________Dept. _____________________________ and protect employees from workplace hazards._____________________________________________________________________________________________emotionPayroll Change Notice _____________________________________________________________________________________________Department _____________________________________________________________________________________________ Department _____________________________________________________________________________________________ Address____________________________________________________________________________________________________Street _____________________________________________________________________________________________ Change Status to Part-Time Temporary Address____________________________________________________________________________________________________StateZIP CodeFLSA Reclassification _____________________________________________________________________________________________ Telephone # ()FLSA Reclassification _____________________________________________________________________________________________ 401(k)/403(b) Contribution _____________________________________________________________________________________________ _______________________________ Date of Birth (for administrative use only) __________________/ /Payroll Change NoticeYes No Return (Date of return to work)________________________________ Telephone # () 401(k)/403(b) Contribution _____________________________________________________________________________________________StreetCityStateZIP CodeInsurance Eligibility Paid? Social Security # ____________________ Status: _______________________________ Date of Birth (for administrative use only) __________________/ / Leave of Absence:_____________________________________________________________________________________________ Full-TimePart-T Insurance Full-Time TemporaryPart-Time TemporaryOther______________________Date ________________ I.D. # ______________imeligibility _____________________________________________________________________________________________ _____________________________________________________________________________________________Job Title Part-Time Temporary W-4 Attached? Yes NoName _______________________ Title ___________________Classification _____________ Job Title _______________________________ Exempt_____________________________________________________________________________________________Job Title Address/Information Change ________________________________________________________________ Status:Full-TimePart-Time Full-Time Temporary Non-Exempt HourlyOther______________________ Change of Insurance _____________________________________________________________________________________________Exempt Non-Exempt HourlyW-4 Attached? Yes NoDate ________________I.D. # ______________Social Security # ____________________ Job Title _______________________________ Changeof Insurance _____________________________________________________________________________________________ Street Address ____________________________________________________________Change(s) for Current Employee _____________________________________________________________________________________________________________________________________________________________ Layoff _____________________________________________________________________________________________LayoffCity/State/ZIP______________________________________Classification _____________Change(s) for Current Employeeof S From_____________________________________________________________________________________________ Name _______________________ Title ___________________Phone () ____________ Type Length ervice Increase ToComments Length of Service Increase _____________________________________________________________________________________________ FromToCommentsStreet Address ____________________________________________________________ Address Change _____________________________________________________________________________________________ Merit Increase_____________________________________________________________________________________________ Type Merit Increase_____________________________________________________________________________________________Division ___________________ Department______________Shift __________________ Last Day PaidA ddress Change _____________________________________________________________________________________________ (Including Pregnancy)Who Its For:End of Introductory Period _____________________________________________________________________________________________ DemotionEnd of Introductory Period __________________________________________________________________________________________________________________________________________________________________________________________ P Date EffectiveHourPhone () ____________ epartmentPromotion _____________________________________________________________________________________________City/State/ZIP______________________________________ D Demotion _____________________________________________________________________________________________romotion _____________________________________________________________________________________________Department _____________________________________________________________________________________________Check appropriate box:Reevaluation of Current Job _____________________________________________________________________________________________ Reevaluation of Current Job _____________________________________________________________________________________________ _____________________________________________________________________________________________Division ___________________ Department ______________Shift __________________FLSA Reclassification _____________________________________________________________________________________________R Old Rate __________________Per ________________ FLSA Reclassification _____________________________________________________________________________________________Enter on PayrollTransfer to: (Department) _________________________ 401(k)/403(b) ContributionRehire _____________________________________________________________________________________________ehire _____________________________________________________________________________________________ _____________________________________________________________________________________________Check appropriate box: Change Shift to: ___________________________________ 401(k)/403(b) Contribution _____________________________________________________________________________________________ Resignation _____________________________________________________________________________________________ Insurance EligibilityResignation _____________________________________________________________________________________________Change Rate R New RateTransfer to:Per_________________________ Insurance Eligibility _____________________________________________________________________________________________ Enter on Payroll_____________________________________________________________________________________________ Job Title _____________________________________________________________________________________________ etirement(Department)Job TitleRetirement __________________________________________________________________________________________________________________________________________________________________________________________Remove from PayrollChange Withholding Rate (complete new W-4 form)Change of InsuranceSalary/Wage _____________________________________________________________________________________________Salary/Wage _____________________________________________________________________________________________Change of Insurance _____________________________________________________________________________________________Date of Last Payroll Change _________________________ _____________________________________________________________________________________________Change RateFull-Time Change Shift to:___________________________________Layoff offof Service IncreaseSeparation _____________________________________________________________________________________________ Everyone! By law, employers must comply with OSHA safety regulations to Separation _____________________________________________________________________________________________Layof Service Increase __________________________________________________________________________________________________________________________________________________________________________________________FLSA Reclassification:Change Title to: ________________________________LengthShift Change _____________________________________________________________________________________________Remove from PayrollChange Withholding Rate (complete new W-4 form)Length _____________________________________________________________________________________________ Shift Change _____________________________________________________________________________________________ _____________________________________________________________________________________________ Reason for Payroll Change _____________________________________________________________________________________________Merit Increase Transfer _____________________________________________________________________________________________Change Status toPart-TimeTemporaryMerit Increase_____________________________________________________________________________________________Transfer _____________________________________________________________________________________________FLSA Reclassification:Change Title to: ________________________________End of Introductory PeriodUnion Scale _____________________________________________________________________________________________ Union Scale _____________________________________________________________________________________________End of Introductory Period __________________________________________________________________________________________________________________________________________________________________________________________ Merit Increase See Performance Appraisal New Employee romotionOther ____________________________ Return from Leave________________ Leave of Absence: Paid?YesNoReturn (Date of return to work) ____________________ Family/Medical Leave(Including Pregnancy) P Promotion_____________________________________________________________________________________________ prevent work-related injuries and illnesses.Other ______________ Temporary _____________________________________________________________________________________________Change Status toFull-TimePart-Time Address/Information Change _______________________________________________ Reevaluation of Current Job _____________________________________________________________________________________________ Leave of Absence Begin Leave______________ Return from Leave________________ Reevaluation of Current Job Leave of Absence Begin Leave / / / / Family/Medical Leave YesNoOther ________________________________________________________________ Rehire_____________________________________________________________________________________________Return (Date of return to work) / /Leave of Absence: Paid? Promotion/ / ____________________ _____________________________________________________________________________________________Educational PersonalRehireEducational Personal ___________________________________________________________________ esignation __________________________________________________________________________________________________________________________________________________________________________________________Address/Information Change _______________________________________________ Other ______________________________ R Resignation _____________________________________________________________________________________________Reason for Termination: (Please complete Exit Interview form.)Short-Term Disability Long-Term DisabilityOther ______________________________Short-Term Disability Long-Term Disability Retirement ________________________________________________________________________________________________________________________________________________________________Retirement _____________________________________________________________________________________________Voluntary DischargedLaid Off Other_______________Salary/Wage _____________________________________________________________________________________________ / /Date EffectiveHour _________________ Last Day Worked _________________ / /Salary/Wage Separation Separation Date _________________ Last Day Worked _________________ Last Day Paid_______________Separation Separation Date/ / / / / / / /_____________________________________________________________________________________________ _____________________________________________________________________________________________Date EffectivePer ____________ SeparationVoluntary Separation YesInvoluntary SeparationNotice of COBRA Rights Provided on_____________/ /Old RateVoluntary Separation Hour Involuntary SeparationNotice of COBRA Rights Provided on_____________/ /Separation ________________________________________________________________________________________________________________________________________________________________________________________________________Remarks: __________________________________________________________________________________________ hift Change _____________________________________________________________________________________________Election of COBRANo Start Date of Coverage_______________/ /Election of COBRAYesNo Start Date of Coverage_______________/ / S S hift Change_____________________________________________________________________________________________Old Rate ______________ Per ____________ ransfer _____________________________________________________________________________________________New RatePer T Transfer If yes, describe type of coverage elected:_____________________________________________________________________________If yes, describe type of coverage elected:_____________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ nion Scale _____________________________________________________________________________________________Date of Last Payroll Change __________________ U Union Scale Additional Comments ________________________________________________________________________________________________New RatePer _____________________________________________________________________________________________Additional Comments ________________________________________________________________________________________________Other ____________________________ eReturn from Leave ________________ Family/Medical Leave(Including Pregnancy) Date ________________Why Sell It: _______________________________________________________________________________________ Other ______________ __________________________________________________________________________________________________________________________Date of Last Payroll Change ____________________________________________________________________________________________________________________________________________ Leave of Absence Begin Leave / / / /Reason for Payroll Change Leave of Absence Begin Leave______________ Return from Leave________________/ / / /_______________________________________________________________________________________ Educational Employee Signatur (Optional)_________________________________________________________________________ / /PersonalName and TitleReason for Payroll Change (Optional)_________________________________________________________________________Date ________________ Educational Personal Family/Medical Leave(Including Pregnancy)Merit IncreaseSee Performance AppraisalNew Employee / / Short-Term Disability Long-Term DisabilityOther______________________________ Date ________________Employee SignatureName and Title Short-Term DisabilityLong-Term DisabilityOther ______________________________ / /Merit IncreaseSee Performance AppraisalNew EmployeeDate __________________ Supervisor/Designated Manager Signature_____________________________________________________________ Submitted By__________________________Title ___________________________ Date ________________ Separation Separation Date _________________ ayrollDay Worked _________________Name and Title / / Date ________________PromotionOther __________________________________________ / /Supervisor/Designated Manager Signature_____________________________________________________________ PromotionOther __________________________________________ / / Separation Separation Date// / Involuntar LastManager igned to pr / / a adu Last Day Paid_______________ / / / /Name and Title / Last Day Worked/ / Last Day Paid/ / _________________ _________________ _______________Reason for Termination: (Please complete Exit Interview form.)Title ___________________________ Date __________________ Voluntary Separation Human Resources/P Signature ___________________________________________________________Approved By __________________________ Name and Title Date ________________Involuntary SeparationNotice of COBRA Rights Provided on_____________/ /Human Resources/Payroll Manager Signature ___________________________________________________________ y Separationovide acc Notice of COBRA Rights Provided on_____________ Reason for Termination: (Please complete Exit Interview form.) a s s Other te for legal advice and does not provide leugtailn ogp tihniios npsr oodnu acnt yisVoluntary Separation YesNo StartThi ated of Coverage_______________ g ta t ye r se nProvide essential posters to help businesses safeguard employees.Name and TitleVoluntaryDischargedLaid OffOther e forElection of COBRAYes No Start Date of Coverage_______________/ / e informaa n tion. However, i tt i t iy s novto alv seudb isnti tcurteea tfoinr gl,e pgraol adducviincegaonr dd disoterisb nuotitn pgr othviids pe rloegdaulc ot pisin nioont lsi aobnl ea nfoyrsapneyc idfiacm faacgtessElection of COBRAs prouctis des u rw teh tnhe auntdheorrsittaatnidvin VoluntaryT This productstoisrdseesravmiceasg.e Ts ahrei sininfogr omuta toifo nth iesupsreo voird ienda wbiiltithy t thoeuusned tehrisst aproduct. You are urged to consul ,t al advcsiintug aotion and any specific questions or concerns you may ha If yes, describe type of coverage elected:D / it/h p on or n iDischargedigned to provide accurate and authoritative informatinodni.n Hg othwaetv aenr,y i tp iesr nsoontao rs uebnsttiittyu itn avno lavtteodr nine ycr ceoanticnegrn, pinrogd yuocuinr gp aorrt idciusltarribIf yes, describe type of coverage elected:aripsionrgt aonuttnoote: Thi ved for use by the purchase orh sies rpvriocdesu.c Tt hisedinesfiogrnmeadt itoon p riso vpirdoev iadcecdu rwaitteh a tnhdeauuntdheorrsittaatnidvein ign ftohramt aantiyo np.e rHsoown eovr entityycinovnoclevrendi ningcyo_____________________________________________________________________________Remarks: ____________________________________________________________________ ngle gpicruodlaur _____________________________________________________________________________ A Im Laid Offer, it is not a substiturteuart ipar ice anr dd disoterisb nuotitn pgr othviids pe rloegdaulc ot pisin niootn lsi aobnl ea fnoyr s apneyc idfiacm faacgtessve. Additional Comments 2022 ComplyRight, Inc. or services. Tfh teh ei nufsoesoisraipnpabroirmation ilsi tpyr toov uidseed this product. Youraorne luy.r Tgehdi st ofo cromn smualty a nno att btoe rsnheayr ecdo npcuebrlnicinlyg o yro wuri tpha trhtiircdu lpaar rstiiteusa.tion and any specific questions or concerns you may have.npoetc liifaibcl efa fcodr a annyy d specific questions or concerns you may have. Imrispionrgt aonuttnoof tteh:e T uhsiesoisraipnpabroilvietydtfoo ru uses et hbiystphreo dpuucrtc.h Yaoseuraornel yu.r Tgehdi st ofo cromn smualty a nno at tbtoer snheared publicly or with third parties. A2168 Two easy ways to reorder: hrdirect.com800-999-9111Iimtupaotriotann at nnote: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties. ________________________________________________________________________________________________Remarks: ________________________________________________________________________________________________________________________________________ Additional Comments ________________________________________________________________________________________________A22102628 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-911122102720 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111____________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________Name and Title / /____________________________________________________________________ Employee Signature(Optional)_________________________________________________________________________Date ________________/ /Employee Signature _________________________________________________________________________ Date ____________________________________________________________________________________ Standard, 3-Part(Optional) Name and Title / / StandardSubmitted By __________________ Title ____________________ Date _____________ Supervisor/Designated Manager Signature_____________________________________________________________Date ________________Name and Title / /Submitted By __________________ Title ____________________ Date _____________ Supervisor/Designated Manager Signature_____________________________________________________________ Date ________________ Approved By ___________________ A I d fTitle ____________________ Date _____________ Carbonless A Human Resources/Payroll Manager Signature ___________________________________________________________a / / When to Sell:Name and TitleApproved By ___________________ Title ____________________ Date _____________ Human Resources/Payroll Manager Signature ___________________________________________________________ Date ________________/ /Name and Title Date ________________Name and Titlefaacmtsa ogre sse arrvisiciensg.oTuhte o ifn tfhoer musaet ioorn i nisa pbriolivtyid teod use thi thoritative information. However,iotr i se nntoitt yaisnuvbosltvietud tien f ocrr elaegtianl ga,d pvriocdeu acnind gd oore sd nisottr ipbruotviindgetlhegisa pl roopdinuicot nissnonot a lniayb slep feocirf aicn yThis rpvriocdesu.c Tt hisediensfiogrnmedat tioon p riso vpir toov iudseed t hwiist hpr tohdeu ucnt.d Yeorsut aanrde iunrgg ethda tto a cnoyn psuerlts oannoartt eonrney concerning your particular situation and an t provide legal opisin nioont lsi ao n any speyc idfaicm faacgtessve.This product is designed to provide ac urate and authoritative information. However, it is not a substitute for legal advice and does not provide legal opinions on any specifico de accurate and authoritative information. However, titi tiysninovto alv seudb isnti tcurteea tfoinr gl,e pgarol daducviicnegaonrd d disoterisb nuotiyn gs ptehciisf ipcr oqduuesctti ons or c obnlcee fronrs a ynou may haym daacmts aogre ss earrvisicinegs.oTuhte o ifn tfhoer musaet ioorn i nisa pbriolivtyid teod u wsei tthh tihs pe ruondduecrts. taYonudi anrgetuhragte adn tyopceornsosunl to ran e natttitoyr ninevyo clvonedc einrn cirnega tyionugr,ppraortdiucucilnagrsoirt udaitsitornib auntidn gan tyh issp pecroifdiuc qctu ies sntiootn lsi aobrl ec ofonrc aernnys arr isseionrgt aonuttnoof tteh:e T uhsiesiosraipnparboilvietyd for use by the purchaser only. This form may not be shared publicly or with third parties.This product is designed to provide acurate a wndit hau ths ep ruondduecrts. tYaondui anrgetuhragte adn tyopceornssounlt an atorney concerning your particular situation and any specific questions or concernsThis product is designed to provide accurate and authoritative information. However, it is not a substitute for legal advicnegaonrd d idsotreisb nuotitn pgr othviisd pe rleogdaulc ot pisi nniootn lsi aobnl ea nfoyr s apneyc idfaicm faacgtessoup omratya nhta nvoe.te: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties. orr issienrvgi coeust.oTf hteh ein ufsoer mora itnioanb iilsi tpyr toov iudseed t hwiist hpr tohdeu ucnt.d Yeorsut aanrde iunrgg etdh atto a cnoyn psuerlts oannoatr teonrtnietyycinovnoclevrendi ningcyroeuart ipnagr,t picruoldaur csiituation and any specific questions or concerns you may have.youp omray have.te: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties. Imp22107223 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111 22102628 ComplyRight, Inc. Important note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.Im tant noA22017223 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111 2022 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111A2168 Two easy ways to reorder: hrdirect.com800-999-9111Compact 3-Part Carbonless Year-round. General safety posters are required in nearly every state. Payroll Status Change Notice Understanding GHS Hazard Document all job and salary changes, including reclassification, transfers and promotions.List new hire information, leave of absence and separation data. Ensure employee files Communication Labelinghave updated, current payroll records. Carbonless form instantly provides copies for the employee, CHOKING Follow these steps for adults and children over 8 years of age who have an obstructed airway.OSHA has updated the requirements for labeling of hazardous chemicals to Use common sense with any serious injury. Call 911 (or other emergency number) for assistance right away. Know the type of injury and the exact location of the victim. Avoid moving the victim whenever possible; bring help to him/her instead. Know where AEDs and supervisor and HRs personnel files first aid kits are kept. This information does not take the place of CPR (Cardiopulmonary Resuscitation) training. For emergency first aidalign with the Globally Harmonized System (GHS). As of June 1, 2015, all labels and CPR training, contact your Human Resources Department, local Red Cross or American Heart Association. will be required to have pictograms, a signal word, hazard and precautionary statements, the product identifier, and supplier identification. A sample revisedIncludes a ComplyRight guide to help you document label, including the required label elements, is shown at left. Supplemental job and salary changes the right way 1 Determine Choking is recognizable when the victim CANNOT breathe, coughLabel configuration may vary from this example. information can also be provided on the label as needed.if the victimor talkno air is moving through the persons throat. Ask, Are youLabels must contain the following required elements:choking? If the victim can breathe, cough or speak, stand by, but is choking: do not interfere.Product Identifier Hazard PictogramsPayroll Change NoticeLists the name or number used for the hazardous chemical.Conveys health, physical and environmental hazard A2170Standard, 3-Part Carbonless 2 If the victim is NOTStand behind the victim and wrap your arms around the personsIt provides a unique means by which a reader can identifyinformation assigned to a hazard class and category. talking, coughing waist above the navel. Make a fist, with thumb side against thethe chemical. Includes a symbol plus other graphic elements, such as stomach (above the waist and well below the breastbone), a border, background pattern, or color. There are eight A2173Compact, 3-Part Carbonlessor breathing: and grasp your fist with your other hand. mandatory OSHA pictograms designated under OSHAs Supplier Identification Hazard Communication Standard for application to a hazard category.Price per pkg/50. Standard: 8 x 11, Compact: 5 x 8. 3 Pull your fistUse quick upward and inward thrusts. Repeat as necessary, untilLists the name, address and telephone number of theSignal Wordschemical manufacturer, importer, or other responsible party.toward thethe obstruction is cleared or the victim becomes unconscious.Indicates the relative level of severity of the hazardPayroll/Status Change Noticevictims stomach: If this should happen, call 911 immediately. and alerts the reader to a potential hazard on the label. Precautionary Statements Danger is used for the more severe hazards, while A21683-Part Carbonless Describes recommended measures that should be taken towarning is used for the less severe. These are theA2172Standard4 If the victim Carefully lay the victim on his or her back, protecting the head andminimize or prevent adverse effects resulting from exposureonly two signal words a reader will see on a label.neck. Open the airway by placing one hand on the victims forehead and the other hand under the chin and gently tilt the head backto a hazardous chemical or improper storage or handling.becomes (head tilt-chin lift). Keep the mouth open. Check for obstructionPrice per pkg/50. Standard: 8" x 11", Compact: 5" x 8".unconscious: in the airway. If you see an obstruction, reach in and take it out. Hazard Statements Supplemental InformationIf you dont see anything, immediately attempt chest compressions.Lists standard OSHA phrases assigned to a hazard classLists any other information provided by the labeler suchand category that describe the nature of the hazard. as the physical state of the chemical or directions for use.Locate the middle of the breastbone by drawing an imaginary line between the nipples. Place the heel of one hand just below that5 Begin chestline and then place the heel of the second hand on top of the first HCS Pictograms HealthFlame Exclamationso the hands are overlapped. Straighten your arms, lock elbowsand lean over so your shoulders are in line above your hands.Using the heels of both hands, firmly push straight downHazard Markcompressions: approximately 2 inches but no more than 2.4 inches on the chest. IrritantRelease pressure completely between pushes, keeping your handsand HazardsCarcinogenFlammables18 Employee Management Forms on the victims chest at all times. Allow the chest to return to its place Safety & Training ToolsPyrophorics (skin and eye) 19Work Hazard CommunicationMutagenicitySelf-HeatingSkin Sensitizernormal position completely after each compression. Avoid leaning on the chest between compressions. Count the number of Acute Toxicitycompressions by saying one and two and threePush hardReproductive ToxicityNarcotic Effectsand push fast (rate of 100 to 120 compressions a minute). Standard PictogramsRespiratory SensitizerEmits Flammable GasRespiratory Tract Irritant Target Organ ToxicitySelf-ReactivesHazardous to Ozone LayerIf you are not trained in CPR or are uncomfortable with your ability to provide rescue breaths, skip steps 6 and 7 and continue performing chest compressionsAspiration ToxicityOrganic Peroxides (Non-Mandatory)at a rate of 100 to 120 compressions a minute until an AED arrives and is ready for use, the victim begins to move or EMS personnel take overAs of he vic ne1, 2015, the Hazard care of tJu tim.Communication Standard (HCS) willGasCorrosion ExplodingOpen the airway by placing one hand on the victims forehead and the other hand under the victims chin and gently tilt the victimsrequire pictograms on labels to alert Cylinder Bomb6 After 30 compressions head back (head tilt-chin lift method). Maintaining the open airway,users of the chemical hazards to which Gases Under PressureEye DamageExplosivesgently pinch the victims nose shut and cover the mouth with yours, creating an airtight seal, or use a mouth guard as shown. Give thethey may be exposed. Corrosive to MetalsSelf-Reactivesopen the airway andvictim two full, slow rescue breaths. Each rescue breath should Each pictogram consists of a symbol on Skin Corrosion/BurnsOrganic Peroxidesbe delivered in one second and should cause the chest to rise.begin rescue breathing: Make sure you take a regular (not a deep) breath between eacha white background framed within a red rescue breath. This prevents you from getting dizzy or lightheaded.border and represents a distinct hazard(s). Watch the victims chest. If it does not clearly rise and fall after theFlame OverEnvironment Skull andfirst rescue breath, perform the head tilt-chin lift again before givingThe pictogram on the label is determinedCircle (Non-Mandatory) Crossbonesthe second rescue breath. by the chemical hazard classification.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.A cute Toxicity OxidizersAquatic Toxicity (Fatal or Toxic)7 After delivery of twoRepeat the combination of 30 chest compressions and two rescue2022 ComplyRight, Inc.W0720 T I nhvios lvperodd iunc ctr iesa dtiensgig, nperdo dtuoc pinrogv oidr ed aisctcruibruattein agn tdh aisu pthroordiutactti ivse n inofto lriambalet ifoonr .a Hony wdeavmera,g iet si sa nriositn ag s ouubts toitf uthteefuors el eogra il naadbviliictey a tnod u dseo etsh ins optr pordouvcidt.e Y loeuga alr oep uinrgioedn st oo nco annsyu sltp aecni afitct ofarcntesyocro snecrevrinciens.g T yhoeu irn pfoarrtmicautiloarnsiist upartoivoind aend dw aitnhytshpee ucinfidce qrsuteasntdioinngsotrh acto anncey rpnesr ysoonuomr aeyn htiatvye. breaths, remembering to release all pressure between pushes and toimportant note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.watch the chest rise and fall during breaths. You should continue this rescue breaths: combination of compressions/breaths until an AED arrives, the victim begins to move or EMS personnel take over CPR.EMERGENCY INFORMATION: CPR VOLUNTEERS: This product is designed to provide accurate and authoritaptiinvieo innsf oornm aantiyo snp.e Hciofiwce fvaecrt,siot ris s eorrv diciesstr. iTbhueti ning this productnot a substitutef oformr laetgioanlis or medical advice and does not provide legal or medicali toyi liintyv otolv eudse i nth cisre partoindgu, cpt.r oYdouu cairneg urged to consult an atorney pisr onvoitd leiadb wlei tfho rt hane yu nddamerastgaensd airnisgi nthg aotu atn oy fp tehres ounse o or re inntab911OR Name: _______________________ Phone:________________________________ and/eossrsmpeecdiifcicaal lplyr oafleonwye odt hine rt hpeh ointostcroupcytiionngs o, rC roemprpolydRuicginhgtpinr oadnuyc fto d any specific questions or concerns you may have.Ambulance:__________________________________________________ U peled to do so. A ssional concerning your particular situation ans rmma, yw bhee tphheort oinc owphieodle o onrl yin w phaernt,tihs es tursicetrl yis p lreoghailblyi ted. conmlLocal Emergency Phone #:______________________________________ Name: _______________________ Phone:________________________________CPR Kit Location:______________________________________________ Name: _______________________ Phone:________________________________2022 ComplyRight, Inc.www.complyright.comW0324'