HR Health and Safety Poster

HR HEALTH AND SAFETY POSTER

Employer Name:   Location (facility):

Emergency Contacts & Reporting

In the event of severe injury, fire, or life-threatening emergency call emergency services immediately and notify the employer contact below. All workplace injuries, illnesses, hazards, or near-miss incidents must be reported to Human Resources within 24 hours.

HR Contact:   Phone:   Alternate:

First Aid, Medical Treatment, and Workers' Compensation

Employees are entitled to prompt first aid and medical evaluation following any work-related injury or illness. The employer maintains workers' compensation insurance and will provide information and assistance with filing a claim. Reporting an injury promptly will not jeopardize employment; retaliation for reporting is strictly prohibited.

Workplace Hazards & Personal Protective Equipment (PPE)

Known workplace hazards at this facility include, but are not limited to: chemical exposures, slip/trip hazards, mechanical risks, electrical hazards, and ergonomic risks. Employees must use required PPE and follow written safe work procedures. Supervisors will provide training and necessary PPE at no cost to employees.

PPE Provided (check all that apply):
Hard Hat Safety Glasses Gloves Hearing Protection Respirator

Evacuation & Emergency Procedures

Evacuation routes and assembly areas are posted at building entrances. Follow supervisor instructions, assist injured co-workers if safe to do so, and proceed to the designated assembly area for headcount. Do not re-enter the building until cleared by emergency responders or authorized personnel.

Hazard Communication & Training

Safety Data Sheets (SDS) and chemical inventory are maintained on site. Employees will receive training on hazardous materials, lockout/tagout, machine guarding, and any task-specific hazards before assignment. If you encounter an unrecognized hazard, stop work and notify your supervisor immediately.

Non-Retaliation and Employee Rights

Employees have the right to report workplace hazards, injuries, and safety concerns without fear of retaliation. Any complaint of retaliation will be investigated and, if substantiated, corrective action up to termination will be taken.

Posting & Record

This poster must remain displayed in a conspicuous area where notices to employees are customarily posted. The employer maintains records of safety training, incident reports, and corrective actions. This document certifies that the poster information was provided to employees and posted at the above facility.

Personal Information

Position Information

Employment History (Most Recent)

Employment History (Previous)

Education

Professional References (3)

Legal Disclosures

At-Will Employment: Unless otherwise specified in a written agreement signed by an authorized representative of the employer, employment is at-will and may be terminated by either the employee or the employer at any time, with or without cause or prior notice.

Equal Opportunity: The employer is an equal opportunity employer. Employment decisions are made without regard to protected characteristics. Reasonable accommodations for qualified individuals with disabilities will be provided in accordance with applicable law when requested.

Applicant / Employee Certification & Authorization

I certify that all information provided in this form is true, complete, and correct to the best of my knowledge. I understand that false statements, omissions, or misrepresentations may result in denial of employment or termination of employment.

Authorization to Contact Previous Employers and Conduct Background Checks: I authorize the employer and its agents to contact my previous employers, educational institutions, and listed references to verify the information provided. I further authorize the employer to obtain background checks, including criminal history and workers' compensation records, where permitted by law. I release from liability all persons and organizations providing information in good faith.

Consent to Receive Safety Notifications: I consent to receive workplace safety notifications and training materials via the contact information provided above.

I certify that I have read and understand the policies and information on this poster and the statements above.

I consent to background checks and contact with prior employers as stated above. I consent to receive safety notifications.

Employee Comments (optional)

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