Appendix A — Employee Acknowledgment of Safety Program
Employee Acknowledgment of Safety Program
3F Construction LLC • 202 N. Justine Street, Chicago, IL 60607 • (312) 296-4855
I acknowledge that I have received the 3F Construction LLC Safety & Health Program (2026 Edition), that its contents have been explained to me, and that I have had the opportunity to ask questions. I understand that compliance with this program is a condition of employment, that I must report injuries and hazards immediately, and that I have stop-work authority for imminent dangers.
Employee name (print) _______________________________________________________
Employee signature __________________________________ Date ________________
Supervisor / trainer __________________________________ Date ________________
Distribution: one copy to the Safety Program Book, one copy to the employee's personnel file.