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WORKER ACKNOWLEDGEMENT FORM (ICS-208-CG SSP-I) <br /> Purpose: The Worker Acknowledgement form is used to document workers who have received safety briefings. <br /> Preparation: Those personnel responsible for conducting safety briefings complete this form initially. Once the briefings are completed, workers <br /> who were briefed print their name, sign, date and indicate the time of the briefing. <br /> Distribution: This form is returned to the Safety Officer or designated representative at the end of each operational period. <br /> Instructions• <br /> Item Item Title Instructions <br /> 1 Incident Name Print the name assigned to the incident. <br /> 2 Site Location Indicate the location where the briefings are held. <br /> 3 Attachments Indicate any attachments used as part of the briefings. <br /> 4 Type of briefing Check the block next to the type of briefing. <br /> 5 Presented by Enter the name of the person conducting the briefing. <br /> 6 Date Presented Enter the date of the briefing. <br /> 7 Time Presented Enter the time of the briefing. <br /> 8 Worker Name, Signature, Workers receiving the briefing print their name, sign, date and enter the time they acknowledge the <br /> Date and Time briefing. <br />