Page 3 - Safety Memo
P. 3
ponsibility po o p p p _________ ________ ___ _ __ _ __ ______ _
ACI, Inc. Safety Orientation
__ _ __ _
Acknowledgement Form
I understand it is the respon I understand and agree to these following safety rules, I understand it is the responsibility of my employer to ensure that I am _______________________________ ____________ _ _ _ __ _ ____ ____ _______ ______ __ _ ____________________________________ _________________ _ _ _____ ______ __ _____ _ _ _ _ ________ ________ _ _ All employees on this job site have the obligation and authorit
rules, Company Name: _______________________________________________________________ __ _ ___ ___ _______ _ _ Employees Name (Print)_________________________________________________________ ___________ __ ___ _ ___ ____ __ _ _ Employee Signature:_____________________________________________ __________________ _ _ _______ _______ _ You SEE it – You OWN it!
properly trained to safely perform my work.
Date:______________________ Job #______________________
