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Safety Agreement

Date:

Construction Company:

Address:

Employee:

Phone/Fax/Email:

Project number:

Project name:

I have been shown the location of the first-aid kit, emergency telephone numbers and fire extinguisher.

I have received instruction in the use of the fire extinguisher, safety goggles, hard hat, and other equipment particular to my trade.

I have been issued a hard hat and will wear it at all times when working on the job site.

I have received a copy of the Job Site Accident Prevention Program; I have read it, I understand it, and will comply with each and every provision.

In case of injury, I will report it either to the superintendent or foreman.

I will report any unsafe conditions to the superintendent or foreman.

Dated:

Signed: _____________________