AGREEMENT between BROWARD COUNTY and Cummings ...

Exhibit 2
Page 201 of 379
ORIENTATION ACKNOWLEDGMENT FORM
My signature below acknowledges my completion of the project safety orientation and review of
XXXXXXXXXX Project and Security rules and regulations. I agree to adhere to these, as well as
all other specific project rules and regulations.
Check as covered:
Clothing Requirements
Eye Protection
Head Protection
Fall Protection
Welding & Burn Permits
Work Permits
Fire Protection
Scaffolds
Drug, Alcohol and Weapons
Security
Employee’s Guide to Florida WC Managed Care Program
Please print clearly.
Last Name:
Identification Card Data Sheet
First Name:
SSN: ____-___-______ Contractor:
Subcontractor:
Trade: ________________________
Home Telephone Number: (____) ____-_________
I have received and understand the Employee’s Guide to Florida WC Managed Care Program.
Signature
Date
A photo ID will be required at the time the project identification card is issued.
Contractor Safety Representative Conducting Orientation
_______________________________________________ ____________________________________
(Signature)
(Please print name)
O