Employer: Trainer Qualification(s): Type of Training Provided: State Designated Trainer □ Trained Train the Trainer for Workers □ Worker Handler □ □ Trained Train the Trainer for Handlers □ EPA Approval Number of Materials Used: Certified Private or Commercial Applicator □ _______________________________ Certificate #: Issuing State: Expiration Date: Documentation of the trainer’s qualifications is on file with the employer and can be requested from the employer if not provided with this card. Certification can be verified with the issuing state.
Employer: Type of Training Provided: □ Worker □ Handler EPA Approval Number of Materials Used: _______________________________ Trainer Qualification(s): □ State Designated Trainer □ Trained Train the Trainer for Workers □ Trained Train the Trainer for Handlers □ Certified Private or Commercial Applicator Certificate #: Issuing State: Expiration Date: Documentation of the trainer’s qualifications is on file with the employer and can be requested from the employer if not provided with this card. Certification can be verified with the issuing state.