“Cousin It” Adams 1313 Mockingbird Way Tulelake, CA 96134

99
“Cousin It” Adams 1313 Mockingbird Way Tulelake, CA 96134

description

“Cousin It” Adams 1313 Mockingbird Way Tulelake, CA 96134. ADDRESS. AGE. APPLY HERE. APPLICATION. 4 /xx/xx. APRIL. 8 /xx/xx. AUGUST. AUTHORIZED PERSONNEL ONLY. CAUTION. CITY. Modoc. Siskiyou. Klamath. Josephine. COUNTY. DANGEROUS. 6/17/82. 10/7/05. 11/24/05. DATE. - PowerPoint PPT Presentation

Transcript of “Cousin It” Adams 1313 Mockingbird Way Tulelake, CA 96134

“Cousin It” Adams

1313 Mockingbird Way

Tulelake, CA 96134

ADDRESS

AGE

APPLY HERE

APPLICATION

4/xx/xx

APRIL

8/xx/xx

AUGUST

AUTHORIZED PERSONNEL

ONLY

CAUTION

CITY

Modoc

Siskiyou

Klamath

Josephine

COUNTY

DANGEROUS

6/17/82 10/7/05

11/24/05

DATE

D.O.B. ______________5/15/1992

DATE OF BIRTH

1-5-2006

DAY

12/xx/xx

DECEMBER

EMPLOYEES ONLY

$

BOSS

EMPLOYER

2/xx/xx

FEBRUARY

FIRST

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 23 25 26 27 28

FRIDAY

1/xx/xx

JANUARY

7/xx/xx

JULY

6/xx/xx

JUNE

KEEP AREA CLEAN

12-31-2006

LAST

3/xx/xx

MARCH

5/xx/xx

MAY

MIDDLE

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 23 25 26 27 28

MONDAY

MONTH

Hello, my ___________

is Dracula.

NAME

11/xx/xx

NOVEMBER

10/xx/xx

OCTOBER

867-5309

348-3927

PHONE NUMBER

PRINT

REPORT

Name Johnny Bravo

Description of Accident

I fell and broke my arm.

___________________

REPORT ALL ACCIDENTS

SAFETY RULES

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 23 25 26 27 28

SATURDAY

9/xx/xx

SEPTEMBER

John DoeX _________________________

SIGNATURE

123-45-6789

SOCIAL SECURITY NUMBER

CA

ORAZ

WA

NM NV

AK

IDVA

WV

NY

MTCO

UT

STATE

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 23 25 26 27 28

SUNDAY

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 23 25 26 27 28

THURSDAY

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 23 25 26 27 28

TUESDAY

USE EAR PROCTECTION

WATCH FOR TRUCKS

WEAR SAFETY

GLASSES

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 23 25 26 27 28

WEDNESDAY

20051776

1492

1991 1812

YEAR

97601

77831

96134

ZIP CODE