ACKNOWLEDGEMENT OF RECEIPT OF 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
• 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 Name (Please Print)
Job Title or Position
THIS FORM SHOULD BE SIGNED, DATED AND RETURNED TO THE PRODUCTION MANAGER.
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SHAPE (Safety & Health in Arts Production & Entertainment)
280 –1385 W. 8 Ave., Vancouver, BC V6H 3V9 Tel: (604) 733–4682
Fax: (604) 733–4692 Email: firstname.lastname@example.org Website:www.shape.bc.ca