Safety and Health Specialist Certificate Program

Transcription

1 Application A Safety and Health Specialist Certificate in Construction, General Industry, Industrial Hygiene, or Fire Prevention & Life Safety is awarded to candidates who successfully complete the core and elective requirements listed by area of specialty. Participants in the can tailor their course requirements to meet specific workplace safety needs. listed under multiple certificates allow the participant to apply for and work on more than one certificate with each course completion. All courses applied toward certificate program(s) must be taken within 5 years of completion date (completion date must be within 5 years from the oldest class being applied to certificate completion). Please plan accordingly. Please complete this application form and return to: OSHA Education Center/Keene State College 1050 Perimeter Rd., Suite 202 Manchester, NH or fax: Approved course transfers are accepted from any OSHA Training Institute Education Center (OTIEC) in the United States. Up to three comparable OTIEC transfer courses may be applied to each certificate program. A $55.00 non-refundable application fee for each certificate program in which you are enrolling must accompany this initial application form. Please make checks payable to Keene State College. Name: Home: Last First Middle Initial Suffix Employer: Your Title: Employment: Certificate Program(s) you are applying for: q Construction q General Industry q Industrial Hygiene Technician q Fire Prevention & Life Safety X Student s Signature Date of Enrollment Cardholder s Signature Cardholder s Billing Address if different from above Account Number SPECIFY: VISA MasterCard Expiration Date Charge $ (I have authorized credit card payment below.) to my credit card. PAYMENT BY CHECK: Please make checks payable to: Keene State College. Enclosed is my check for $ 1050 Perimeter Road, Suite 202 Manchester, New Hampshire Fax: oshaed@keene.edu

2 Form Please retain this form and the Course Record grid. When you have completed the assigned core requirements and appropriate number of electives for your certificate program, complete these forms, attach ONLY copies of course completion certificates transferring from another OSHA Education Center, and: to fax: mail to: Keene State College Safety Education Center 1050 Perimeter Rd., Suite 202 Manchester, NH Your Safety and Health Specialist Certificate will be mailed to you within 30 days of our receipt of this Form, copies of your course certificates and the Course Record grid. Name: Home: Last First Middle Initial Suffix Employer: Your Title: Employment: Please indicate DATE of COMPLETION, and which Certificate Program(s) you are completing: / / month day year q Construction q Industrial Hygiene Technician q General Industry q Fire Prevention & Life Safety Please indicate to which address would like your certificate to be sent: q Home q Business 1050 Perimeter Road, Suite 202 Manchester, New Hampshire Fax: oshaed@keene.edu

3 Construction Requirements Course Record OSHA Standards Course (Construction) Excavation, Trenching & Soil Mechanics Principles of Scaffolding Electrical Standards Fall Protection Safety & Health Management Introduction to Incident/Accident Investigation Industrial Hygiene Hazardous Materials Cranes in Construction Permit Required Confined Space Evacuation & Emergency Planning Health Hazard Awareness Transitioning to Safer Chemicals Understanding Permit Req1uired Confined Space Standards Hearing Protection Program for General Industry & Construction NCSH EM 385 OSHA Governmental Safety & Health Requirements for Contractors NCSH Hands-On Fall Protection NCSH Principles of Work Zone Safety ammended

4 General Industry Requirements Course Record OSHA Standards Course for General Industry OSHA Guide to Industrial Hygiene Machinery & Machine Guarding Standards Principles of Ergonomics Lock Out Tag Out Safety & Health Management Introduction to Incident/Accident Investigation Hazardous Materials Permit-Required Confined Space Entry Electrical Standards Public Warehousing and Storage Evacuation & Emergency Planning Introduction to Combustible Dust Health Hazard Awareness Transitioning to Safer Chemicals OSHA Permit-Required Confined Sp. Standards Hearing Protection Program for General Industry & Construction Fall Hazard Awareness NCSH Conducting EHS Audits NCSH Electrical Safe Work Practices ammended

5 Industrial Hygiene Technician Requirements Course Record OSHA Guide to Industrial Hygiene Noise Assessment & Control NCSH Introduction to Toxicology NCSH Industrial Ventilation NCSH Workplace Air Contaminant Sampling Prerequisite: 521 NCSH Globally Harmonized Systems Principles of Ergonomics Transitioning to Safer Chemicals NCSH Radiation Protection NCSH Biohazards in the Workplace NCSH Laboratory Safety NCSH Indoor Air Quality

6 Fire Prevention & Life Safety Requirements Course Record OSHA Standards for General Industry Hazardous Materials Electrical Standards Introduction to Combustible Dust NCSH 400/ /7 Fire Prevention & Life Safety Evacuation & Emergency Planning Introduction to Safety & Health Management OSHA Guide to Industrial Hygiene Lock Out/Tag Out Bloodborne Pathogen Exposure Control Health Hazard Awareness Permit-Required Confined-Space Introduction to Incident/Accident Investigation Disaster Site Worker NCSH Industrial Ventilation NCSH Radiation Protection NCSH Electrical Safe Work Practices