Employee Safety And Health Record

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EMPLOYEE SAFETY AND HEALTH RECORD

The AF Form 55 will be maintained by the supervisor in the work place. This form is intended to provide a method to document employee safety training, it is not

intended to set forth training requirements. This form may be filed with AF Form 971, Supervisor's Employment Brief, for civilian personnel and filed with any record

for military personnel.

1. NAME (Last, First, Middle Initial)

2. GRADE

3. ORGANIZATION, OFFICE SYMBOL, FACILITY NUMBER

4. OCCUPATIONAL SERIES OR PRIMARY AFSC 5. DUTY TITLE

I. PERSONAL PROTECTION USED

II. PERSONAL PROTECTION PROVIDED IN WORK AREA

1. FOOT PROTECTION -

2. ARM/HAND PROTECTION -

3. EYE PROTECTION -

4. HEARING PROTECTION -

5. RESPIRATORY PROTECTION -