ACKNOWLEDGEMENT OF RECEIPT OF PRODUCTION SAFETY GUIDELINES PRODUCTION I understand that there is a health and safet by pbn10852

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									    ACKNOWLEDGEMENT OF RECEIPT OF PRODUCTION
               SAFETY GUIDELINES
PRODUCTION: ___________________________________________________________

I understand that there is a health and safety program in place and hereby confirm that I have read and
understood the production Safety Guidelines.

If applicable, I acknowledge that I have read and understand one or more of the following supplemental
instructions:

                                                                                     (Initial)

             •      Occupational Health and Safety Regulation                        ______
             •      Occupational First Aid Regulation (Part 3)                       ______
             •      Fall Protection Regulation (Part 11)                             ______
             •      Personal Fall Protection Equipment                               ______
                    (safety harnesses, lanyards, lifelines)
             •      Workplace Hazardous Materials Information System                 ______
                    (W.H.I.M.S.) (Part 5)
             •      Other ____________________________________                       ______

I also understand that I must attend a safety awareness orientation from my supervisor before
commencement of any work.


_______________________________________
Employee’s Signature


_______________________________________
Employee’s Name (Please Print)


_______________________________________
Job Title or Position

_______________________________________
Date

   THIS FORM SHOULD BE SIGNED, DATED AND RETURNED TO THE PRODUCTION MANAGER.




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                         SHAPE (Safety & Health in Arts Production & Entertainment)
                                       th
                         280 –1385 W. 8 Ave., Vancouver, BC V6H 3V9 Tel: (604) 733–4682
                         Fax: (604) 733–4692 Email: info@shape.bc.ca Website:www.shape.bc.ca

								
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