Klein Tool Safety Orientation

I agree and authorize Klein Tool to payroll deduct $10.00 if I do not return my name badge.
I understand that I must return the item by Monday following my last day worked or my final paycheck will be reduced by the amount owed.
I understand that if I return the item after that Monday, I will be reimbursed the following pay period.

Employee’s Signature:  _____________________________________  SS#: _________________________

Staffing Supervisor:      _____________________________________  Date: _________________________

Internal Use Only:

Returned Items:                                             Date Returned:            Verified By:         Owe:

Klein Tools Name Badge               $10           _____________              ____________          ____________

Total Owed:                                                                                                        Total:  ____________

Please forward copy to payroll when employee assignment ends. Keep original in employee file.

I have received Klein Tools Inc. Safety Orientation for New Employees, which discussed Employer and Employee Responsibilities pertaining to the following:

General Safety Items:

• First Aid
• Injury Reporting
• Material Handling Equipment
• Housekeeping
• Chemical Use and Storage
• Back Safety and Proper Lifting
• Compressed Air
• Electrical Safety

Specific Safety Programs:

• Bloodborne Pathogens
• Hazard Communication
• Emergency Action Plan
• Personal Protective Equipment
• Noise and Hearing Conservation
• Lockout / Tagout
• Machine Guarding
• Powered Industrial Trucks
• Hazardous Materials
• Confined Spaces

Instructor:  ________________________________________________________   Date:  _______________

Employee:  ________________________________________________________   Date:  _______________

I understand that my assignment at Klein Tool will require that I have a negative COVID 19 PCR test.  I understand that Klein Tool will pay for the required testing.

I agree that if I fail to complete my assignment with Klein Tool for any reason, the full amount, of $85 will be deducted from my final payroll check.

__________________________________________       _________________________________________________     ___________

Printed Name                                                    Signature                                                                     Date