Submit copies of this completed and signed application and all required documentation of successful course completion for all courses to (Name & Contact information for approving OTI Education Center) along with a check, credit card, or money order for $95 (enter respective OTI Education Center payment processing information). Required documentation is either a course completion certificate or official transcript from the OTI Education Center where the course was completed. OSHA #7300 Understanding OSHA's Item 1 Applicant Name Permit-Required Confined Space Standard List full legal name. (7 hours) OSHA #7000 OSHA Training Item 2 Title Guidelines for Safe Patient Handling (7.5 List current job title. If currently not working, hours) leave this field blank. OSHA #7005 Public Warehousing and Item 3 Storage (7 hours) List current employer. If currently not working, OSHA #2045 Machinery &Machine leave this field blank. Guarding (26 hours) OR Item 4 E-Mail OSHA #7100 Introduction to Machinery List a current email where you may be and Machine Safety Guarding (4 hours) contacted. OSHA #7105 Introduction to Evacuation Item 5 Applicant Address and Emergency Planning (4 hours) Provide a current address, phone and fax OSHA #7115 number where you may be contacted. Lockout/Tagout [Controlling Hazardous Energy to Item 6 Completed Course(s) Prevent Workplace Injury] (7.5 hours) Check the box which corresponds to the OSHA #7200 Bloodborne Pathogens applicable OSHA course(s) completed. Exposure Control for Healthcare Facilities (7 hours) OSHA Course Prerequisites Must have complete the three (3) required OSHA #7205 Health Hazard Awareness courses: (6 hours) OSHA #511 Occupational Safety and OSHA #7210 Pandemic Influenza and Health Standards for General Industry Workplace Preparedness (5.5 hours) OSHA #7500 Introduction to Safety and OSHA #7845 Recordkeeping Rule Health Management Seminar (4 hours) OSHA #7505 Introduction to Accident [Incident] Investigation Must have complete a minimum of four (4) of the following elective courses that include a minimum of 29 contact hours of training: OSHA #3095 Electrical Standards (26 hours) OSHA #521 OSHA to Industrial Hygiene (26 hours) OSHA #2255 Principles of Ergonomics (26 hours) OSHA #2264 Permit-Required Confined Space Entry (20 hours) OR
Submit copies of this completed and signed application and all required documentation of successful course completion for all courses to (Name & Contact information for approving OTI Education Center) along with a check, credit card, or money order for $95 (enter respective OTI Education Center payment processing information). Required documentation is either a course completion certificate or official transcript from the OTI Education Center where the course was completed. Item 1 Applicant Name List full legal name. Item 2 Title List current job title. If currently not working, leave this field blank. Item 3 List current employer. If currently not working, leave this field blank. Item 4 E-Mail List a current email where you may be contacted. Item 5 Applicant Address Provide a current address, phone and fax number where you may be contacted. Item 6 Completed Course(s) Check the box which corresponds to the applicable OSHA course(s) completed. OSHA Course Prerequisites Must have complete the three (3) required courses: OSHA #511 Occupational Safety and Health Standards for General Industry OSHA #7500 Introduction to Safety and Health Management OSHA #7505 Introduction to Accident [Incident] Investigation Must have complete a minimum of four (4) of the following elective courses that include a minimum of 29 contact hours of training: OSHA #3095 Electrical Standards (26 hours) OSHA #521 OSHA to Industrial Hygiene (26 hours) OSHA #2255 Principles of Ergonomics (26 hours) OSHA #2264 Permit-Required Confined Space Entry (20 hours) OR OSHA #7300 Understanding OSHA's Permit-Required Confined Space Standard (7 hours) OSHA #7000 OSHA Training Guidelines for Safe Patient Handling (7.5 hours) OSHA #7005 Public Warehousing and Storage (7 hours) OSHA #2045 Machinery &Machine Guarding (26 hours) OR OSHA #7100 Introduction to Machinery and Machine Safety Guarding (4 hours) OSHA #7105 Introduction to Evacuation and Emergency Planning (4 hours) OSHA #7115 Lockout/Tagout [Controlling Hazardous Energy to Prevent Workplace Injury] (7.5 hours) OSHA #7200 Bloodborne Pathogens Exposure Control for Healthcare Facilities (7 hours) OSHA #7205 Health Hazard Awareness (6 hours) OSHA #7210 Pandemic Influenza and Workplace Preparedness (5.5 hours) OSHA #7845 Recordkeeping Rule Seminar (4 hours)
Application-Verification-Form-General-Industry-FINAL.docx