High-Rise Work Waiver Form

High-Rise Work Waiver Form
Complete this form to acknowledge and accept the risks associated with high-rise work activities.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer / Company Name
Job Site Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Work
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Description of Work to Be Performed
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Waiver and Assumption of Risk

I acknowledge that working at heights involves inherent risks, including but not limited to the risk of falls and serious injury. I voluntarily assume all risks associated with this work activity and agree to comply with all safety requirements and instructions. By signing below, I confirm that I have read, understood, and accept these terms.
Signature
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