Safety Method Statement Acknowledgement
Please confirm you have read, understood, and will follow the method statement for the specified job.
Job/Task Being Acknowledged
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Site/Location
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Date of Acknowledgement
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 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Full Name
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First Name
Last Name
Role/Position or Company Name
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Have you completed the required training or possess the necessary competency for this job?
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Yes
No
Briefly describe any significant hazards and the control measures you will follow for this job.
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I confirm that I have read, understood, and agree to follow the method statement for this job/task.
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I acknowledge and agree
Signature
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Submit Acknowledgement
Submit Acknowledgement
Should be Empty: