I, hereby attest that on above entered date,
I completed an online site safety training course in accordance to the requirements of the Administrative Code, the Rules of the City of New York, rules, regulations, policies, procedure notices and directives issued by the New York City Department of Buildings. I further attest that I completed the training without assistance.

I do hereby further attest that the information provided on this application is true, accurate and correct to the best of my knowledge.

In addition, I am willing to submit documentation to support this claim if necessary and accept that if I am unable to provide this documentation or a discrepancy in my supporting documentation is later determined, my NYC Site Safety Identification Card (Temporary, Limited, Full, Supervisor) issued by NYC DCCTC may be revoked.