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Certification of Employee <br />Safety Training, <br />Employee's Full Name: SSN <br />Location of Training: j'fe SAf) (o vnn, <br />t <br />Date Training Provided:—&—/o`er/ o Total Time Spent Training: Dcc.Y <br />Type of Training Provided: <br />(check all that apply) <br />❑ Classroom <br />❑ Video <br />Written Plan, Policy, or Procedure , <br />Safety Newsletter for: Jan Feb Mar Apr May Jun Jul Aug Sep Qct Nov Dec { <br />❑ Other <br />Title of Training: <br />.I hereby acknowledge that the above mentioned safety training class and /or material has <br />been provided to me. If the material is written I hereby acknowledge I have received my <br />own copy, read it, and understood.the safety material presented. <br />- G <br />Employee's Signature: Date: !Q ., <br />Instructor Certification <br />I certify that I presented, provided, and/or prepared the above noted safety material <br />and/or information to the above mentioned employee. <br />Instructor Name: ja c y, 6arm,rc , q, Signature: Date: <br />Please provided this completed form to your supervisor/foreman so he/she may promptly return it to the Elon Golf <br />Construction office for review, signature, and filing. <br />"SAFETY is what we do for our employees:.. not what we do to them!" <br />