Go to Directory of IIPP Forms

Download and print this form as a (Word-32K) or (PDF-8K) document

University of California, Berkeley
Injury & Illness Prevention Program - Form 5

SAFETY TRAINING ATTENDANCE RECORD

Department:
Topic of Training Session:
(attach a copy of the training session curriculum)

Instructor(s):	Location:	Date:	Time:	Length:

We are legally required to maintain records regarding our safety training activities. Please assist us by providing the information indicated below to document your attendance. Thank you.

Name (Please Print)																																																		Department																																																		Campus Extension																				Employee I.D. (if available)																				Official Payroll Title																														Signature
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

For questions on any item, please contact your Department Safety Coordinator or call EH&S at 642-3073.

IIPP - Form 6	Completed copies of this form must be kept in the department files for at least one year.
Rev. 10/02/01