Mining Hazard Training Acknowledgement Form
Confirm that you have received and understood mining hazard training. Please complete all sections accurately.
Worker full name
*
First Name
Last Name
Contact email address
*
example@example.com
Contact phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Job title or work area
*
Date of training
*
-
Month
-
Day
Year
Date
Training topics covered (select all that apply)
*
Hazard identification and assessment
Use of personal protective equipment (PPE)
Emergency response procedures
Safe operating procedures
Reporting hazards and incidents
Other
Do you understand the mining hazards and safety procedures discussed in the training?
*
Yes, I fully understand
I need further clarification
Supervisor or trainer name
*
Supervisor or trainer email
example@example.com
By signing below, I acknowledge that I have received and understood the mining hazard training.
*
Submit acknowledgement
Submit acknowledgement
Should be Empty: