CHP1 online reading submit form

Submit report of completion of online reading for CHP1 Intro training part 1.

Read all instructions carefully, complete all fields, and use the SUBMIT button below to send the information.

1. First Name

If you are in the Purdue Directory please give your last name as it appears in the Purdue Directory , and your "alias" as your email.

2. Last Name

3. Department

4. Workroom(s) -- include bldg(s)

5. email (alias*)

6. Staff/student Classification*

7. Job title*

8. Supervisor   (use professor name if your are in a research group)
       (summer interns type SURF)
    (Faculty may choose to name themselves as the supervisor.)

All fields are required.		review this topic
I have completed reading all the relevant training material here.	9.
I have been informed of:
the contents of the OSHA lab standard and its appendices and where I can see a copy of them.	10.
the location and availability of the Purdue CHP.	11.
the location and availability of safety information.	12.
the signs and symptoms of exposures to the hazardous chemicals used in my workplace.	13.
the Permissible Exposure Limits for the hazardous chemicals used in my workplace.	14.

I have received training about:
the methods and observations that may be used to detect the presence or release of the hazardous chemicals in my workplace.	15.
physical and health hazards of the hazardous chemicals in my workplace	16.
measures I can take to protect myself from these hazards	17.
the details of the Purdue Chemical Hygiene Plan which apply to my workplace.	18.
I understand that I am to ask my supervisor, Safety Committee, and/or REM staff members any questions I have about occupational safety and health	19.

Department of Chemistry people working with lab chemicals must sign up for live training (called "CHP2") the FIRST TIME they go through Purdue CHP training. Other Departments requirements may differ.
Choose one of these: (links will follow submission) (summer research program participants choose "I am not affiliated with Dept of Chemistry."

*Staff classification, alias, and job title.

Summer research program participants enter "summer research" in this field.

Many part time and student employees do not know their staff classification, and that's fine and something we can work around. The "alias" is quite important. Many of the "regular" employees can find their job title by looking up their own information in the Purdue Electronic Directory.

Students who are not paid at all, but are here because they are in a research course such as CHM 499 or SCI 490S, simply put the course designation in both of the blanks for Job Title and Staff class. Other questions, email swihart@purdue.edu

**Department.

This is the department you are working in, as a paid staff member or as a researcher for credit (as do many undergraduates). Undergrads do NOT put in your academic major department. (Unless of course it is the same as your research group.)

***Faculty member CHP training completion.

If you are a member of the tenured/eligible faculty, your academic department has not explicitly instructed you to sign up for the live training session, you may check this option to indicate that by your own recognition you have obtained adequate training and skills to perform your job and supervise your research staff and other subordinates safety and competently.