FLSA Hazardous Orders Minor Training Acknowledgment

Documents that a minor employee has been instructed on applicable FLSA Hazardous Orders and power-driven equipment restrictions, with a sign-off retained in the employee file.

Submission Notice

• What happens after I submit?

Employee Information

• Employee Name
• Employee ID
• Work Location
• Date of Acknowledgment

Hazardous Orders Instruction

• Has the minor been instructed on applicable FLSA Hazardous Orders and work restrictions?
• Date Instruction Was Completed
• Topics Covered
• Were prohibited tasks and equipment reviewed with the minor?

Equipment and Work Restrictions

• Were restrictions on power-driven equipment reviewed?
• Equipment Types Reviewed
• Other restrictions or prohibited duties explained

Acknowledgment and Signature

• I acknowledge that I was instructed on the applicable hazardous orders and understand I must not perform prohibited tasks or use restricted equipment.
• Minor Signature
• Supervisor or Trainer Name
• Supervisor or Trainer Signature