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<br />•~r CAC CHECKLIST <br />NAME( J'Gf~ '~~ / /c ~~~~ CO_` COMMITTEE ~~~ <br />~ / l~il <br />PHONE ~Cf ~1 `yG~'~ l J y ~1~~° '70/ iS'~/~~.~Z <br />Screened: By: <br />Welcomg~ Letter and Materials Sent: ~ ` ~' ~ % a o~ <br />Orientation and Training Notice sent: ~%~~0° 7 "~q~~ ~ <br />~f~~SO `~30 X007 <br />5n~,~-n <br />Event <br />1 ... Classroom <br />Date Completed In-facility <br />Dn e Completed <br />1 -3 -~~aN <br />2 8 a~c~ <br /> <br /> <br />OCTS Qate Entered: (~-~D-~~LY~~/ <br />Nametag Date Mailed: <br />~y/~~ r <br />Removal : <br />Request Letter Sent: <br />Reason <br />l~~ac~~ CQ.P~ec~"/te G1~C ,~.vu~cY/'/-YEwiwl"~ ll•!17 ~~2 ~~ <br />9-06 <br />+-E - r <br />