Capasso Enterprises New Hire Attestation

Download and review the three documents below. Once you have read and understood the documents, please fill out the form below with as much information as possible and then sign your name and submit this form. By signing this form you are attesting that you have received, reviewed, and understood the Company Safety Program and the safety requirements of the company.

Company Safety Program
Job Hazard Analysis
Appendix D

After you have completed the form, please go to this link (or scan the QR to the right) and complete the Safety Orientation Training.

Prior to beginning any work each employee will agree to and understand the safety rules at Capasso Enterprise Inc.:

  • I have a minimum of a 10 hour OSHA Card and I have submitted a copy to the main office.

  • I know the location of the Safety Manual, Safety Data Sheet’s (SDSs) and other safety documents on site in the Capasso Enterprises trailer, Main Office and/or Construction Managers trailer.

  • I have read, been trained and understand Capasso Enterprises’ Respirable Crystalline Silica Plan and will comply with the requirements of this plan as put forth by OSHA.

  • I have read, understand and signed the “Acknowledgement for Voluntary Use of Self-Provided Respirators”.

  • I will not use any elevated platform/scaffold unless it has been erected and inspected by a competent person prior to each shift, and is green tagged.

  • I have been trained and am competent to perform work on scaffolds, which includes the nature of electrical, fall and falling object hazards and the correct procedures for dealing with those hazards, proper use of the scaffold and proper handling of materials, and the maximum intended load and the Load carrying capacity of the scaffold.

  • I know that they can find the companies OSHA 300 Logs for the prior 3 years in the main office

  • I can identify key people on the project including - competent persons on site for erecting staging and operating machinery, Job Foreman, Safety director, GC /Cm., and Capasso Enterprises’ Project Manager.

  • I will wear at all times Personal Protective Equipment PPE including Hard Hats, Safety Glasses; high visibility clothing, gloves and ear plugs when required. Respirators are required when cutting, grinding, chipping, drilling, mixing concrete grout, mortar or any other silica exposure. Full face shields AND safety glasses are required when cutting, grinding, drilling, chipping, or using any portable power tool.  I must be medically cleared and fit tested prior to wearing a respirator.

  • I have to wear the Acceptable Dress Code which is (long Pants, Shirts w/4” Sleeves min and ankle high boots)

  • I know the location of the first aid kit, fire extinguishers, Emergency Telephone Numbers, Drinking Water and Emergency Evacuation Instructions.

  • I have received fall protection equipment and received hands-on instructions on how to property select, inspect don/adjust, identify appropriate anchor point, and use of specific equipment.