Laboratory Safety Training Documentation Form

Environmental Health & Safety

E H & S

TEL NO: (818) 677-2401

FAX NO: (818) 677-5853

MAIL DROP: 8284

Laboratory Safety Training Form

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I. EMPLOYEE INFORMATION:
Employee's Last Name:	Employee's First Name:	CSUN ID Number:


Position Title:	Department:	Telephone:

Training Provided By:

Title:

Date:

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II. SUBJECTS COVERED:		Yes	No
1.	BASIC LABORATORY RULES AND STANDARD OPERATING PROCEDURES
2.	CONTENT AND REQUIREMENTS OF THE LABORATORY STANDARD
3.	CONTENT, LOCATION, AND AVAILABILITY OF THE CHEMICAL HYGIENE PLAN
4.	USE AND LOCATION OF MATERIAL SAFETY DATA SHEETS AND OTHER REFERENCE MATERIALS (LINKS)
5.	THE EXPOSURE LIMITS FOR HAZARDOUS CHEMICALS USED ON THE EMPLOYEES LABORATORY
6.	SIGNS AND SYMPTOMS ASSOCIATED WITH EXPOSURES TO THE HAZARDOUS CHEMICALS USED IN THE LABORATORY(S)
7.	AVAILABILITY AND USE OF PERSONA PROTECTIVE EQUIPMENT (PPE)
8.	BASIC EMERGENCY RESPONSE PROCEDURES
9.	HAZARDS UNIQUE TO THE LABORATORY

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III. CERTIFICATION:
I HEREBY ACKNOWLEDGE THAT I HAVE RECEIVED TRAINING ON THE SUBJECTS INDICATED ABOVE:
*Signature:*	______________________________________________
Print Name:
Date:	____________________