Knowledge assessment record for occupational safety and health requirements

Date prepared: Date the record was prepared. Assessment date: Knowledge assessment date. Training was provided by: Employee's employer​. The commission was established by order: Number and date of the order establishing the commission​. Chair: Commission chair: full name​. Commission members: Commission members: full names, positions; each signature​.

Training programs and duration: Name and duration of each program (hours)​. Approval details: Program approval details​. State each program name and its hours separately. If first-aid training or training in the use of personal protective equipment (PPE; СИЗ) is combined with training in occupational safety and health requirements, issue one record only where the Rules so provide; do not replace different actual results with one overall passing grade. Assessment: planned.

Registration number of the knowledge-assessment entry in the trained-person register: Registration number of the entry in the trained-person register​. Commission chair (or deputy chair): ______________. Signatures of all commission members: ______________. Employee who completed the assessment: ______________ / Assessed employee: full name​ /.

At the employee's request, provide the record or an extract from it on paper. The training organization shall provide the record or an extract to the employer of its employees upon request. Electronic execution does not remove these obligations.