Stop Work Authority Acknowledgment
Document Control Company: [COMPANY NAME] · Logo: [COMPANY LOGO] · Address: [COMPANY ADDRESS] Prepared by: [RESPONSIBLE PERSON] · Date: [DATE] · Approved by (signature): _________________
| Field | Value |
|---|---|
| Category | New-Hire Safety Orientation |
| Recommended Industry | All |
| Document Type | Acknowledgment |
| Access Level | Starter |
| Last Reviewed | 2026-06-29 |
| Last Updated | 2026-06-29 |
How to Use This Template
Have the employee read the content, then sign and date. Keep the signed acknowledgment in the employee's training or personnel file.
Acknowledgment
I understand that [COMPANY NAME] grants me the authority and responsibility to stop any work I reasonably believe is unsafe, and that I will not face retaliation for doing so. I understand the process: stop the affected work, make the area safe, notify my supervisor, and ensure the hazard is corrected before work resumes.