IIPP-6

INDIVIDUAL STAFF MEMBER TRAINING RECORD

NAME OF TRAINER: _______________________________________________________________

TRAINING SUBJECT: ______________________________________________________________

TRAINING MATERIALS USED: ______________________________________________________

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NAME OF STAFF MEMBER: ________________________________________________________

DATE OF HIRE/ASSIGNMENT: ______________________________________________________

I, ________________________________, hereby certify that I received training as described about in the following areas:

1. The potential hazards in general in the work ara and associated with my job.

2. The safe practices which indicate safe work conditions required for my job.

3. My right to ask any questions, or provide any information to my employer on safety either directly or anonymously without reprisal.

I understand this training and agree to comply with safe practices for my work area.

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STAFF MEMBER SIGNATUREDATE: Last Updated - 06/28/01 HOME