Offshore Duty Acknowledgement Form
Complete this form to confirm your assignment details, readiness, safety responsibilities, and compliance for offshore duty.
Full Name
*
First Name
Last Name
Assignment Location
*
Assignment Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assignment End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you prepared and fit for offshore duty as assigned?
*
Yes
No
Select your primary safety obligation on this assignment.
*
Please Select
Personal Protective Equipment Compliance
Participation in Safety Briefings
Hazard Reporting
Emergency Drill Participation
Other
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship
*
Please Select
Spouse
Parent
Sibling
Friend
Other
Submit Acknowledgement
Should be Empty: