EMPLOYEE INDUCTION SIGN-OFF SHEET - Layne Safety

EMPLOYEE INDUCTION
SIGN-OFF SHEET
Signatures attest to the receipt of an employee manual and
safety induction. The employee has been trained and successfully
tested in the proper safety requirements for field operations.
Employee’s Name:
Office Location:
Signature:
Date:
Complete and return the Employee Induction Sign-off
Sheet and Employee Induction Test to the Safety department.
Retain a copy for district personnel files.

EMPLOYEE INDUCTION TEST
NAME:
OFFICE LOCATION:
DATE:
TRUE OR FALSE
1. Hard hats, safety shoes, safety glasses, and gloves
are the four basic personnel safety items each employee
must wear.
2. Safety Blocks and a full body harness are required
when conducting work above the ground at a height of
1.8 meters or more.
3. Lockout/tagout of electrical systems are NOT required
if the crew leader is present.
4. Portable fire extinguishers are to be inspected every 5
years.
5. Mechanical methods should be used to move heavy
materials.
Mechanical methods should be used to
6.
move materials.
7. Smoking is allowed in any area when no one else is
around.
8. Accidents do not need to be reported to
your supervisor.
9. List two hazardous materials used in your area.
1.)
2.)