Cheeba Chews Baked Taffy

Safety Acknowledgment & Release Form Cut and Fold Wax Wrapper Candy Machine Line


I, , the machine operator, understand that the cut and fold wax wrapper candy machine is an essential piece of equipment in our candy production process. To ensure my safety and the safety of others, I agree to follow the safety guidelines listed below:

  1. Training: I have received proper training on the operation and maintenance of the cut and fold wax wrapper candy machine line. I have watched the instructional videos, read the machine manuals, and have received hands on training provided by Cheeba Chews as well as, received an SOP manual. (Which may be updated from time to time)
  2. Protective Equipment: I agree to always wear appropriate personal protective equipment (PPE) while operating or maintaining the line. This includes safety glasses, gloves, and any other required PPE. If I choose not to wear PPE I do so at my own risk.
  3. Machine Operation: I will follow the manufacturer's guidelines for operating the machines, including using the correct settings and maintaining a safe distance from moving parts.
  4. Maintenance and Cleaning: I will perform regular maintenance on the machines as required by the manufacturer, including cleaning, lubrication, and inspection of parts.
  5. Machine Inspection: I will inspect the machines for any potential hazards or malfunctions before, during, and after each use.
  6. Reporting Issues: I will immediately report any malfunctions, damages, or safety concerns related to the cut and fold wax wrapper candy machine line to my supervisor to be reported to Cheeba Chews. I will not operate the cut and fold wax wrapper line until the appropriate repairs can be made by or guided by an authorized technician.
  7. Safe Work Environment: I will maintain a clean and organized work area around the machines to minimize the risk of accidents. A minimum of 36” of uninterrupted workable space is required around the wax wrapping machine line. The wax wrapping machine line cannot be operated in a high traffic area.
  8. Lockout/Tagout: I will follow the lockout/tagout procedures when performing maintenance, repairs, or cleaning on the machine to ensure it is properly de-energized and cannot be accidentally restarted. The machine will either be powered off, or a safety door will be opened causing the sensor to prevent operation.
  9. Safety Sensors: I will never remove any of the safety sensors from the safety doors/guards. I agree to never operate machines these sensors in place, and with all safety doors and guards closed.
  10. Emergency Procedures: I am familiar with the emergency procedures in case of accidents or injuries related to the cut and fold wax wrapper candy machine line. I am familiar with the location of all emergency stop buttons and how to use them. I understand that opening a safety door will also stop the machines in an emergency. I will immediately report any accidents to my supervisor.

By signing this agreement, I acknowledge that I have read and understood the safety guidelines for operating the cut and fold wax wrapper candy machine and agree to follow them at all times.

The undersigned hereby assumes all risk of injury or harm as a result of the misuse of the equipment specified above and agrees to release, indemnify, and forever hold harmless Cheeba Chews, EW Licensing LLC, or any of their employees from all liability, claims, demands, damages, costs, expenses, and causes of action due to death, injury, loss, or damage to the undersigned.

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Signature Certificate
Document name: Safety Acknowledgment & Release Form Cut and Fold Wax Wrapper Candy Machine Line
lock iconUnique Document ID: 9d5138a688c365aed99e10b7aa6dc3991960a299
Timestamp Audit
February 14, 2024 5:20 pm MDTSafety Acknowledgment & Release Form Cut and Fold Wax Wrapper Candy Machine Line Uploaded by Eric Leslie - marketing@cheebachews.com IP 162.237.97.127
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