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A <br />APEX <br />APEX-SGI SUBCONTRACTOR TRAINING AND MEDICAL CLEARANCE RECORD <br />Apex-SGI Subcontractor: <br />Address: <br />Employees Assigned to Project: <br />I certify the above employees assigned to this project have received training, medical clearance, <br />and respirator fit-testing according to the Health and Safety Plan and the Occupational Safety and <br />Health Administration Standard on Hazardous Waste Operations and Emergency Response (29 <br />CFR 1910.120). If any of these employees are injured, I will submit an incident report to the Apex- <br />SGI Health and Safety Director within 24 hours. <br />Name: <br />Title*: <br />*Subcontractor Supervisor or Manager only. <br />Signature: <br />Date: <br />