EMPLOYEE ACKNOWLEDGEMENT OF RECEIPT OF TRAINING

IN UNDERSTANDING

Company Name:

GENERAL GUIDELINES FOR FALL PROTECTION

I, acknowledge receipt of training with regard to the general guidelines for fall protection set forth by . Specifically, I have read through the safety guidelines and understand that it is my responsibility to recognize when fall protection concerns must be addressed to protect myself and others around me. I further understand that if I do not know how to safely manage a situation where fall hazards are present, I must not proceed until I have either been properly trained or received assistance.

Training was received on this day of , Year

Employee's Signature Date

Trainer's Signature Date