Take a Kid to Work Sign-Off TAKE A KID TO WORK SIGN-OFFWorkplace / Site AddressDate of VisitEmployee NameEmployee EmailEmployee PhoneStudent Name(s) and Age(s)Emergency Contact NameEmergency Contact PhoneAllergies or Medical NeedsWorkplace Safety Notes Read these notes with your student before the visit. If a rule here differs from a site rule, follow the stricter one. Supervision Stay with your student at all times. Hand over to another adult only if your supervisor has agreed and your student knows that person. Sign in and out at reception, and keep any visitor badge visible. Keep your student in the office, meeting rooms and common areas unless a guided tour has been arranged. Warehouse, shop and vehicle areas Students do not enter warehouse, shop, loading dock, racking or service areas without a guide and the required protective equipment. Forklifts and other moving equipment have the right of way. Stay inside marked walkways and stop at crossings. Students never ride on, sit on, climb on or operate forklifts, lifts, ladders, racking or other equipment. Stay clear of raised loads, charging stations, chemicals and anything marked with a warning sign. Clothing and protective equipment Closed-toe, flat shoes are required. Tie back long hair and avoid loose clothing. Wear any protective equipment that the area requires, such as a safety vest, safety glasses or hearing protection. Office safety Do not use shredders, paper cutters, kitchen appliances or tools without an adult helping. Keep aisles and doorways clear, and walk on stairs and in hallways. Do not touch other people’s computers, phones or files. Ask before taking photos, as some information is confidential. Emergencies, injuries and health When you arrive, show your student the nearest exits, the muster point and the first aid station. If an alarm sounds, stay together, leave by the nearest exit and go to the muster point. Report every injury or near miss to your supervisor right away, however minor. Bring any medication your student needs, and keep your student home if they are sick. I have read these safety notes and reviewed them with my student. I will supervise my student for the entire visit and will take my student off site if I can no longer supervise them or if asked to do so.Notes / CommentsDate SignedEmployee Signature Sign Here Chain Reference Inc., 133 Ellenville Crescent, Ariss, ON N0B1B0 Phone: 519-763-9487 Submit Form