FLSA Hazardous Orders Minor Sign-Off

Documents that a minor employee has been instructed on applicable FLSA Hazardous Orders, including power-driven equipment restrictions, and acknowledges understanding for the personnel file.

Employee and Training Details

• Employee Name
• Employee ID
  Optional internal identifier for the personnel file.
• Date of Training
• Work Location
• Trainer / Supervisor Name

Hazardous Orders Instruction

• I was instructed on the FLSA Hazardous Orders that apply to my job duties.
• I was instructed that I may not operate restricted power-driven equipment unless specifically permitted by law and company policy.
• Topics Reviewed
• Other Topics Reviewed
• Have your job duties changed since your last hazardous orders acknowledgment?

Conditional Duty Review

• New or Changed Duties
• Additional instruction was provided for the new or changed duties.
• Restricted tasks were removed from the minor's assigned duties, if applicable.

Acknowledgment and Signature

• I understand the hazardous orders restrictions that apply to my job and agree to follow them.
• I had the opportunity to ask questions and received answers I understood.
• Employee Signature
• Parent / Guardian Signature
  Collect only if required by company policy or applicable state law.
• Signature Date