Safety Quiz and Safety Orientation Acknowledgement
Joshua Pressley
EMPLOYEE NAME: ____________________________________ 7600
LAST 4 DIGITS OF SS# _____________
1. It is up to me to report unsafe conditions to my supervisor.
a. True b. False
2. It is safe to complete a task that I have not been trained to perform.
a. True b. False
3. Which of these items are examples of Personal Protective Equipment (PPE)?
a. Safety glasses.
b. Steel toed boots.
c. Ear plugs.
d. All are correct.
4. The employer shall provide and make accessible information about all chemicals in the workplace.
a. True b. False
5. Appropriate clothing and footwear must be worn on the assignment at all times.
a. True b. False
6. If I see a close call or near-miss it is important to report it to keep someone from getting hurt.:
a. True b. False
7. I must wear my personal protective equipment:
a. when I feel like it. c. at all times, and places required by the employer.
b. if it’s not too hot. d. only when I’m doing something dangerous.
8. I am required to wear a seat belt at all times when operating any vehicle.
a. True b. False
9. Pushing a load is easier on the back.
a. True b. False
10. Operating a machine without proper training may result in a serious injury.
a. True b. False
11. It is okay to start a "Locked Out" machine.
a. True b. False
12. If you have a machine that has a missing guard:
a. It is okay to operate the machine.
b. Operate the machine slowly.
c. Call maintenance.
d. Do not operate the machine and report the issue to your supervisor.
13. It is okay to carry and use my cell phone while on the job.
a. True b. False
14. If you are injured on the job you should:
a. Try and treat yourself.
b. Don't say anything because it might get you in trouble.
c. Report it immediately to Roper/FRSI and your supervisor.
d. Look for someone skilled in First Aid.
15. It is okay to horseplay a little while on the job.
a. True b. False
16. Personal Protective Equipment (PPE) is really not that important while on the job.
a. True b. False
17. Keeping my work area clean helps to prevent accidents.
a. True b. False
18. I am responsible for maintaining my PPE.
a. True b. False
19. The Safety Data Sheet provides the required information about all the chemicals in the workplace.
a. True b. False
Safety Orientation and Training Acknowledgement
I acknowledge that I have read and understand the Safety Policy and Safety Rules that are included in my
Employee Handbook and that they were discussed with me during my orientation. I understand that as an
employee it is my responsibility to abide by Roper Staffing's and the client company's safety policy and
procedures and any on-the-job training provided by Roper's client company.
If I have questions about the training and materials provided by Roper Staffing and/or the client company's
policies and procedures, I understand it is my responsibility to seek clarification from the person conducting
the safety orientation and training prior to performing the job.
Employee Signature:Joshua Pressley (Apr 28, 2022 14:06 EDT) Printed Name:
Joshua Pressley
Date: 04/28/2022 Conducted by: Summerville