Employee Acknowledgment of COVID-19 Protective Measures in the Workplace 

Health & Wellness
Safety & OSHA

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This sample acknowledgment is intended as written documentation of employee receipt of your policies and protocols regarding the mitigation efforts you have implemented to comply with public health orders and to reduce the risk of exposure to COVID-19 in the workplace.

Employers should refer to their respective state, county, or local jurisdiction public health orders for any specific employer requirements and modify this sample accordingly.

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