Free Printable Employee Liability Waiver Template

PRINTABLE EMPLOYEE LIABILITY WAIVER

[Your Company Name]

Date: June 1, 2055
Employee Name: Malcolm Raynor
Position: Machine Operator
Department: Manufacturing


I. Acknowledgment of Risk

By signing this waiver, I, Malcolm Raynor, acknowledge that my job at [Your Company Name] may involve high-risk activities. These risks may arise from, but are not limited to:

  • Use of heavy machinery and tools

  • Handling and exposure to hazardous materials

  • Physical exertion, lifting, or repetitive tasks

  • Working in environments with potential for injury, such as construction sites, manufacturing facilities, or laboratories

I understand that these activities may carry inherent risks of accidents, injuries, or other adverse outcomes.

II. Assumption of Responsibility

I agree to assume full responsibility for any risks, known or unknown, associated with my role. I commit to following all company safety protocols, including but not limited to:

  • Wearing required personal protective equipment (PPE)

  • Adhering to company safety procedures and training guidelines

  • Reporting any unsafe conditions or incidents to my supervisor or safety officer immediately

III. Waiver of Liability

In consideration of my employment with [Your Company Name], I agree to release, waive, and discharge [Your Company Name], its officers, employees, and agents from any liability related to personal injuries, property damage, or accidents arising from:

  • My use of or exposure to machinery and tools

  • Contact with hazardous materials

  • Any work-related tasks that involve physical exertion or hazardous environments

Exceptions: This waiver does not apply in cases where [Your Company Name] demonstrates gross negligence or willful misconduct.

IV. Medical Fitness and Disclosure

I confirm that I am physically and mentally fit for the duties required in my role. If I have any medical conditions that could be affected by my job tasks, I will notify [Your Company Name] in writing and seek appropriate medical guidance before performing such tasks.

V. Indemnification

I agree to indemnify and hold harmless [Your Company Name] from any claims, damages, or legal costs arising from my failure to follow safety protocols or comply with company policies related to high-risk activities.

VI. Signature and Agreement

By signing below, I acknowledge that I have read, understood, and agreed to the terms of this liability waiver. I understand that this waiver is binding for the duration of my employment with [Your Company Name] in any high-risk position.

Malcolm Raynor
Date: June 1, 2055

Lyda Fadel

HR Manager
[Your Company Name]

Date: June 1, 2055

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