EMPLOYEE ACKNOWLEDGEMENT OF RECEIPT OF TRAINING

IN UNDERSTANDING

Company Name:

GENERAL GUIDELINES FOR PREVENTION OF SLIPS, TRIPS AND FALLS

I, acknowledge receipt of training with regard to the general guidelines for slip, trip and fall safety set forth by . Specifically, I have read through the safety guidelines and understand that it is my responsibility to recognize when slip, trip and fall hazards exist and where precautions must be employed to protect myself and others around me. I further understand that if I do not know how to safely manage a situation where slip, trip and 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