Lists/Tables/Plans/Diagrams/Maintenance Verification
Safety instructions
Statement
I
(last name and first name)
have received this safety information. I have been informed that the driver is under
strict instructions to stop the loading process as soon as any person or persons
approach the danger zone.
I am aware of the locations of the danger zones on the Maus. If I am accompanied
by children or minors, I will inform such persons of the dangers, prohibit them from
entering the Hazard zones and I will supervise them appropriately.
Date/signature of the informed person
I have conducted this safety session and I have given the above person a copy of
this safety information.
Date/signature
Please copy this form before completing it!
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