Equipment Rental Safety Addendum Form
Complete this form to acknowledge essential safety and compliance requirements for equipment rental.
Renter Full Name
*
First Name
Last Name
Rental Start and End Dates
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment Description (Make, Model, Serial #)
*
Is the equipment operator at least 18 years old and properly trained?
*
Yes
No
Have you read and understood all provided safety instructions for this equipment?
*
Yes
No
Please acknowledge the following hazards associated with equipment operation.
*
Pinch/crush points
Electrical hazards
Moving parts
Other
Pre-Use Inspection Completed?
*
Yes, inspection completed and no defects found
No, issues found and reported
Describe any issues found during pre-use inspection (or enter 'None').
*
Incident Reporting: I understand I must immediately report any equipment incidents or hazards.
*
I acknowledge
Renter Signature (required)
*
Submit Safety Addendum
Submit Safety Addendum
Should be Empty: