Position: ____________________________________ Trainer: ____________

I acknowledge that I have been trained in the SAFETY AND HEALTH areas checked below, and I agree to follow all SIGN DESIGN & FABRICATION, INC. Safety and Health Rules, Policies and Procedures.

_____Safety and Health Program

• My right to ask questions, or report any safety hazards, either directly or anonymously without any fear of reprisal.
• The location of SIGN DESIGN & FABRICATION, INC. safety bulletins and required safety postings (i.e., summary of occupational injuries and illnesses, and Safety and Health Protection Poster).
• Disciplinary procedures that may be used to ensure compliance with safe work practices.
• Reporting safety concerns.
• Accessing the department safety committee.

_____Incident Reporting & Reporting Occupational Injuries and Illnesses

_____ Hazard Communication

• The potential occupational hazards in the work area associated with my job assignment.
• The safe work practices and personal protective equipment required for my job title.
• The location and availability of MSDS’s.
• The hazards of any chemicals to which I may be exposed, and my right to the information contained on Material Safety Data Sheets (MSDS’s) for those Chemicals.

_____Hazardous Material Spill Response

_____Bloodborne Pathogen Response

_____Personal Protective Equipment

_____Employee(s) Safety Manual

_____Machinery Tag-Out Program

_____Emergency Procedures

_____Other: Topic:___________________________________________________________________

___________________________________________________

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