Vidalia High School Work-Based Learning/Youth Apprenticeship Program

TRAINING PLAN and SAFETY AGREEMENT

(Signatures required: Student and Employer)

Student Name _________________________________ Parent/Guardian Name ________________________________

Employing Company Name __________________________________________________________________
Employing Company Address __________________________________________________________________
Employing Company Supervisors Name _____________________________Work Phone Number _______________ WorkBased Learning Coordinators Name _____________________________________________________________
Donna A. Collins

Task
List tasks the student is
responsible for completing

Proficient; can
perform this task with
little or no supervision

Moderately competent;
some knowledge, but requires
some supervision to perform
this task

Very little or no skill;

needs close supervision
to perform this task

Safety Training Agreement

The employer certifies that the proper procedures related to the job requirements have been shown to the student and that in
the case of an emergency; the student has been given instructions on what to do to resolve the situation.
Employer Signature:

Date:

The student understands that failure to comply with these safety procedures may result in personal injury or injury to others.
Student Signature:

Date: