S
T
L
AFETY
RAINING
OG
I certify that the employee listed below received Safety Training in the subject(s) as indicated.
Department
Date of Training
Subjects(s)
Title(s) of Film(s), video(s) or slide presentation(s) shown to employee:
Q Attached is an outline of the specific items discussed in this training program, along with sample
handouts, if any.
Instructor's Name
(Please Print)
Signature
Date
(Instructor)
Employee Name
Employee Signature
(Please Print)