Workplace Safety Briefing Acknowledgement Form
Please complete this form to acknowledge your participation in the workplace safety briefing and confirm your understanding of the information presented.
Full Name
*
First Name
Last Name
Job Title or Position
*
Department
Email Address
example@example.com
Date of Briefing
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Safety Topics Covered
*
Was the information clear and understandable?
*
Yes
Somewhat
No
If you answered 'Somewhat' or 'No', please specify any unclear topics (optional)
Signature
*
Acknowledge Briefing
Acknowledge Briefing
Should be Empty: