Company Name:

TRAINING PROGRAM NAME:

I, acknowledge receipt of training on OSHA’s Hazard Communication Standard (29 CFR 1910.1200). Specifically, I have been instructed on the types of hazardous chemicals present in work place, and I understand the importance of protecting myself and my fellow workers from exposure to hazardous substances. I have been instructed and understand how to read and evaluate labels and Material Safety Data Sheets and will do my part to make our company a safe working environment.

I further understand that it is my responsibility to immediately inform my manager/supervisor about any hazardous substances that I am not familiar with or do not know how to handle safely. In addition, it is my responsibility, in the spirit of promoting a safe work place, to inform a fellow employee of proper procedures when observing the handling a hazardous substance in an unsafe manner. Finally, I will do my part to insure that proper labels are maintained on all secondary containers that I utilize during the course of my work.

Employee Name and Signature Date

Trainer's/Supervisors Name and Signature Date