A cover page and repeatable log entry recording theory and practice separately under Ministry of Emergency Situations Order No. 1120. The entry format is adapted for printing.
⚠️ This is a blank template, not legal advice: check the wording with a lawyer and adapt it to your jurisdiction and your case.
Required fields not filled: 17. The PDF will have blank lines in their place to fill in by hand.
Click a field label in the text and type, or use the form. Empty fields become blank lines in the PDF.
Facility subject to fire safety requirements: , . Opened on . Closed on . The log is kept on paper; signatures are handwritten. Person responsible for maintaining and storing the log: . Storage and inspection access arrangements: .
Trainee: , . Type: induction. Program: .
| Component | Date | Instructor's full name | Education / qualification / training document | Trainee's signature | Instructor's signature |
| Theory | ______________ | ______________ | |||
| Practice | ______________ | ______________ |
The assessment is not yet complete. This entry does not confirm completion of the briefing or authorize work. Complete the results after actual assessment. Repeat the entry block for each trainee and each briefing actually delivered; results and dates are not entered in advance.
The same entry number in every table refers to one employee and one briefing.
| Entry No. | Trainee's full name | Occupation / position | Briefing type | Ground, if required | Program / version |
| Entry No. | Date | Instructor's full name | Training document | Trainee's signature | Instructor's signature |
| Entry No. | Date | Instructor's full name | Training document | Trainee's signature | Instructor's signature |
| Entry No. | Assessment result | Date | Measures for an unsatisfactory result | Instructor's full name / signature |
Entries are made after the relevant component and assessment have taken place; proper electronic signatures are provided for electronic records.
This is a draft template. Before signing, complete all applicable fields and check the facts, the signatories' authority and current law. This template is not legal advice.
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