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Run: FLSA Hazardous Orders Minor Training Acknowledgment

Use this acknowledgment form to document that a minor employee has been trained on applicable FLSA hazardous orders and power-driven equipment restrictions b...

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Submission Notice

What happens after I submit?

Employee Information

Employee Name (required)

Employee ID (required)

Date of Birth

Optional. Collect only if needed to verify age-based work restrictions.

Work Location (required)

Hazardous Orders Reviewed

Which restricted duties were reviewed with the employee? (required)

Describe the other restricted duty

Training materials used (required)

Acknowledgment and Consent

I acknowledge that I was instructed on the applicable hazardous orders and understand I may not perform restricted duties assigned to my age group. (required)

Yes No N/A

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

Yes No N/A

Is a parent or guardian signature required by company policy? (required)

Parent/Guardian Name

Parent/Guardian Signature

Supervisor Certification

Supervisor Name (required)

Supervisor Title (required)

Date of Instruction (required)

I certify that the minor employee was instructed on the applicable FLSA Hazardous Orders and that this acknowledgment should be retained in the employee file. (required)

Yes No N/A

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