Education Center - Rochester Institute of Technology
Education Center - Rochester Institute of Technology
Education Center - Rochester Institute of Technology
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Register now! Call toll-free 1-866-385-7470 ext. 2919 or visit www.rit.edu/osha for convenient online registration.<br />
Safety and Health Specialist Training<br />
Certificate Program Application<br />
<strong>Education</strong> <strong>Center</strong><br />
Personal Information<br />
Name<br />
Title<br />
Organization<br />
Organization Address<br />
City State Zip<br />
Telephone # Fax #<br />
E-mail address<br />
Application Fee<br />
There is a $25.00 application fee for each certificate.<br />
BY MAIL - with check, credit card, or P.O.:<br />
<strong>Rochester</strong> <strong>Institute</strong> <strong>of</strong> <strong>Technology</strong><br />
OSHA <strong>Education</strong> <strong>Center</strong><br />
31 Lomb Memorial Drive<br />
<strong>Rochester</strong>, NY 14623-5603<br />
BY FAX - with credit card or P.O. to: (585) 475-6292<br />
Payment Information<br />
Purchase order #<br />
Billing address:<br />
Please Circle: VISA / MasterCard<br />
FOR OFFICE USE ONLY<br />
_________________________<br />
Date Received<br />
__________________________<br />
Date Completed<br />
Card Number:<br />
Cardholder’s signature<br />
Exp. Date<br />
Construction Safety & Health Specialist Training Certificate<br />
4 required courses plus 3 electives<br />
Course Completion Date Location<br />
510 or 500 or 502*<br />
3010*<br />
3095*<br />
3110*<br />
521<br />
2225<br />
2264<br />
5600<br />
7205<br />
7400<br />
7405<br />
7410<br />
7500<br />
7505<br />
7600<br />
7845<br />
* Required<br />
General Industry Safety & Health Specialist Training Certificate<br />
3 required courses plus 3 electives<br />
Course Completion Date Location<br />
511 or 501 or 503*<br />
521*<br />
2045*<br />
2015<br />
2225<br />
2250<br />
2264<br />
3095<br />
7005<br />
7100<br />
7205<br />
7300<br />
7500<br />
7505<br />
7845<br />
* Required<br />
Please indicate the courses you have already completed, including training date and location. For classes taken at another training facility,<br />
you must include a copy <strong>of</strong> your certificate. Please note: Only two (2) courses from another training facility may be transferred.