Subject

Initial Training

Retraining

Retraining

Employee Certified?

Date

Trainer's Initials

Date

Trainer's Initials

Date

Trainer's Initials

Blasting & use of explosives

[] Yes [] No

Concrete & masonry

[] Yes [] No

Cranes, derricks, hoists, elevators, & conveyors

[] Yes [] No

Electrical safety

[] Yes [] No

Employee emergency plans

[] Yes [] No

Excavations

[] Yes [] No

Fall protection

[] Yes [] No

Fire prevention plans

[] Yes [] No

General environmental controls:

• Confined spaces
• Lockout/tagout

[] Yes [] No
[] Yes [] No

Hazardous Materials:

• Flammable & combustible liquids
• Explosives & blasting agents
• Bulk delivery & mixing vehicles
• Storage & handling of liquefied petroleum gases
• Process safety management of hazardous chemicals
• Hazardous waste operations & emergency response
• Hazardous waste cleanup
• MSDS

[] Yes [] No

[] Yes [] No

[] Yes [] No

[] Yes [] No

[] Yes [] No

[] Yes [] No

[] Yes [] No

[] Yes [] No

Machinery & machine guarding

[] Yes [] No

Materials handling & storage:

• Powered industrial trucks
• Moving the load
• Crawler locomotives & truck cranes

[] Yes [] No

[] Yes [] No
[] Yes [] No

Motor vehicles & mechanized equipment

[] Yes [] No

Personal protective equipment:

• Hearing protection
• Respiratory protection
• Fire/burn protection

[] Yes [] No

[] Yes [] No

[] Yes [] No

Powered platforms for building maintenance

[] Yes [] No

Scaffolding

[] Yes [] No

Stairways & ladders

[] Yes [] No

Steel erection

[] Yes [] No

Tools, hand & power

[] Yes [] No

Welding, cutting & brazing

[] Yes [] No