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Run: FLSA Hazardous Orders Minor Sign-Off

Record that a minor employee was instructed on FLSA hazardous orders, reviewed equipment restrictions, and acknowledged the limits before working. Use it to ...

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Employee and Training Details

Employee Name (required)

Employee ID

Optional internal identifier for the personnel file.

Date of Training (required)

Work Location (required)

Trainer / Supervisor Name (required)

Hazardous Orders Instruction

I was instructed on the FLSA Hazardous Orders that apply to my job duties. (required)

Yes No N/A

I was instructed that I may not operate restricted power-driven equipment unless specifically permitted by law and company policy. (required)

Yes No N/A

Topics Reviewed (required)

Conditional Duty Review

New or Changed Duties (required)

Additional instruction was provided for the new or changed duties. (required)

Yes No N/A

Restricted tasks were removed from the minor's assigned duties, if applicable.

Yes No N/A

Acknowledgment and Signature

I understand the hazardous orders restrictions that apply to my job and agree to follow them. (required)

Yes No N/A

I had the opportunity to ask questions and received answers I understood. (required)

Yes No N/A

Employee Signature (required)

Parent / Guardian Signature

Collect only if required by company policy or applicable state law.

Signature Date (required)

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Email (required)

Your name (optional)

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