Clinical Laboratory Technician Safety Policy Form
Employee Information
Full Name
Employee ID
Department
Date
Email
Safety Policy Acknowledgement
I acknowledge that I have received, read, and understood the Clinical Laboratory Safety Policies and Procedures:
Yes
Personal Protective Equipment (PPE)
Required PPE (check all that apply):
Gloves
Lab Coat
Goggles
Face Shield
Mask
Other
Reporting Procedures
Please describe the procedure you will follow in case of an accident, spill, or exposure:
Additional Comments
Employee Signature
Date
Supervisor Signature
Date