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<br /> Former dale MGP Model ProjectSafety Plan
<br /> E mployee/Sub contractor Training Acknowledgement
<br /> s
<br /> Name of Trainer: ,;
<br /> Training Subject:
<br /> s
<br /> Training materials used:
<br /> Name of employee:
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<br /> E; y.
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<br /> Date of hire/assignment:
<br /> hereby certify that I have received training as described above in the following areas:
<br /> • Names of personnel responsible for site safety and health.
<br /> • Safety,health or other hazards at the site.
<br /> • The proper use of personal protective equipment.
<br /> • The potential occupational hazards in general in the work area and associated with my job assignment.
<br /> • Work practices by which a worker can minimize risks from hazards.
<br /> • Safe use of engineering controls and equipment on the site.
<br /> • Acute effects of compounds on the site.
<br /> • Decontamination procdures°
<br /> • General safety requirements indicate the safe work conditions,safe work practices and personal protective equipment
<br /> required for my work.
<br /> • The hazards of any chemicals to which I may be exposed and my right to information contained on material safety data
<br /> sheets for those chemicals,and how to understand this information.
<br /> • My right to ask questions,or provide any information to the employer on safety either directly or anonymously without
<br /> any fear of reprisal.
<br /> • Disciplinary procedures the employer will use to enforce compliance with general safety requirements.
<br /> I understand this training and agree to comply with general safety requirements for my work area.
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<br /> Employee Signature Date
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