Safety Sign-off Sheet
Sign-off sheet verifying that all personnel have read and understood the safety instructions.
As a requirement of O.S.H.A., it is necessary for the employer to train the employee in the safe operating
and safety procedures for this equipment. This sign-off sheet is provided for your convenience and per-
sonal record keeping. All unqualified persons must stay out of the work area at all times. It is strongly rec-
ommended that another qualified person who knows the shutoff procedure be in the area in the event of
an emergency.
Date
Employee Name
Supervisor Name
Pneg-4460A
60 Ft Diameter 40-Series Bins
13