Employee Acknowledgement Form printable pdf download

Employee Acknowledgement Form

XYZ EMPLOYER:

SUNSCREEN AND SUN SAFETY

EMPLOYEE ACKNOWLEDGEMENT FORM

Date:______/______/______

Name of

Employee:_________________________________________________________

As an employee of the above business, I recognize that too much sunlight may increase

my risk for skin cancer later in life.

Therefore, I acknowledge that:

I have been educated by my employer on the dangers of UV exposure.

I fully understand that a combination of factors are required to adequately protect

me from UV radiation exposure, including but not limited to sunglasses,

protective clothing, protective headwear, and sunscreen.

I fully understand that the responsibility of protecting myself from UV radiation

exposure is my own.

My employer has made Rocky Mountain Sunscreen available for my use at any

time.

I recognize that my employer has adequately instructed me in the proper use of

this sunscreen product. Specifically, I understand that sunscreen should be

applied to all exposed skin at least 30 minutes prior to sun exposure, including

but not limited to the face, tops of ears, nose, bare shoulders, arms, and legs.

I have consulted with my physician, and do not know of any allergies or allergic

reactions I may have to Rocky Mountain Sunscreen SPF ____.

Employee’s Full Name (Please Print):

Employee’s Full Signature:

NOTE: THIS IS A SAMPLE, AND IS MEANT TO BE SUGGESTIVE ONLY. AS WITH

ANY LEGAL DOCUMENT, WE SUGGEST YOU CONSULT WITH YOUR LAWYER

BEFORE IMPLEMENTING ANY TRAINING ACKNOWLEDGEMENT FORM.

Employee Acknowledgement Form