HomeMy WebLinkAboutC. IIPP Signature Page 2012City of Saratoga
HUMAN RESOURCES DIVISION I TRAINING
Occupational Injury and Illness Prevention Program (IIPP)
Acknowledgement of Policy
I, , acknowledge receipt of the
PRINT Name of Employee or City Official
City of Saratoga's Occupational Injury and Illness Prevention Program (IIPP).
I understand that I am responsible for reading, understanding and complying with this IIPP Document and
Program, the standards of safety conduct and protocols referenced and contained in this IIPP Document and
Program, and City directives, trainings, and requests related to safety. I understand that I am responsible for
attending and paying attention to safety training and meetings where a manager, supervisor or other City
representative discusses safety. I further understand that if I have questions or concerns regarding the Policy
or safety rules or protocols, I can discuss these with my supervisor, manager, director or Human Resource
Manager.
Signature:
Date
Please return this form to the Human Resources Division
UPDATED AND RE -ISSUED SEPTENIBER 11, 2012