AgdaPkt 2006-07-24 - Laserfiche WebLink

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A'f1'ACt\ rt'l€'P' "D EMPLOYEE SAFETY QUALIFICATION 5.1E AND STATUS CONFIRMATION Page 15 EMPLOYEE NAME: MY CRAFT IS: CLIENT ASSIGNED TO: I hereby certify that: 1. I am familiar with OSHA and other safety regulations of agencies having jurisdiction, as they apply to my work classification. 2. I have agreed with my employer (Bay Span, Inc.) that I will comply wIth such safety regulations, as well as with Client's other safety procedures that apply to my work classifications. . 3. I am familiar with and agree to comply with Bay Span's safety procedures. I have completed the IIPP Training Guidebook and Workbook. 4. I understand that I have primary responsibility for my safety. 5. I understand that the cllenfs tools, materials and vehicles are to be used solely for authorized work, and are not to be removed from the client's site. 6. I understand that I am an employee of Bay Span, Inc. and that I am not an employee of the above referenced client and therefore waive any rights to client provided benefits. I understand that benefits are available through Bay Span after 90 days of continuous full time work with Bay Span, Inc. 7. I have read and agree to be bound by the terms and condItions set forth in the Confidentiality Agreement attached. - 8. I understand that safety toed shoes are a requirement of employment with Bay Span, tnc. regardless of individual client guidelines. Current labor laws do not require employers to furnish safety-toed shoes. I am aware of the employe. assistance program to enable me to meet this requirement. EMPLOYEE SIGNATURE: Printed Name: Date: F:/HUman ResourceslFormsIEmployee Safety Quallflcatlons.doc .. ... ... . . ~ . ._.~.... .__, __.._ . _. ... ~.___ ""'" .._._,._..., ....--....._._.~.'.._'.. . ,. '-0'. ., -,