Ergonomics Safety Training Acknowledgment Form
Acknowledge completion of ergonomics safety training and share any workstation follow-up needs.
Trainee Information
Full Name
*
First Name
Middle Name
Last Name
Job Title / Role
*
Department / Team
Please Select
Operations
Manufacturing
Warehouse
Logistics
Administration
Human Resources
Other
Work Location / Site
Please Select
Head Office
Plant 1
Plant 2
Warehouse A
Warehouse B
Remote
Other
Preferred Contact Email
example@example.com
Training Acknowledgment
Training Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Training Format or Delivery Method
*
In-person
Live virtual
Self-paced module
Blended
Acknowledgment of Training Completion and Understanding
*
I completed the ergonomics safety training and understand the key safe work practices covered.
Acknowledgment Statement
*
Workstation Follow-up and Confirmation
Primary Workstation / Setup Area
*
Need Ergonomics Follow-up or Workstation Review?
*
Yes
No
Additional Comments or Concerns
Submit
Should be Empty: