 |
|
|
||||
|
|
EMPLOYEE ACKNOWLEDGEMENT FORM
| I certify that I have read and received a copy of the Injury and Illness Prevention Program and fully understand my responsibilities with respect to the policy and procedures as outlined. I further agree to comply with safe work practices. |
|
Employee's
Last Name:
|
Employee's
First Name:
|
CSUN ID Number: |
| Position Title: | Department: | Telephone: |
|
|
| Signature:____________________________________________ | Date:_____________ |
|
Keep the original Employee Acknowledgement Form in your Departmental Personnel files
Send a copy to EH&S at Mail Drop 8284 |