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Run: FLSA Hazardous Orders Minor Training Acknowledgment

This FLSA Hazardous Orders Minor Training Acknowledgment records that a minor employee was trained on hazardous orders and power-driven equipment restriction...

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Submission Notice

What happens after I submit?

Employee Information

Employee Name (required)

Employee ID

Work Location (required)

Date of Acknowledgment (required)

Hazardous Orders Instruction

Has the minor been instructed on applicable FLSA Hazardous Orders and work restrictions? (required)

Date Instruction Was Completed (required)

Topics Covered (required)

Were prohibited tasks and equipment reviewed with the minor? (required)

Equipment and Work Restrictions

Were restrictions on power-driven equipment reviewed? (required)

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. (required)

Yes No N/A

Minor Signature (required)

Supervisor or Trainer Name (required)

Supervisor or Trainer Signature (required)

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Email (required)

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