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

Please give your names as they appear in the Purdue Electronic Directory e.g. Fatemeh Nasreen Olang

2. Last Name

3. Department

4. Workroom(s) --  include bldg(s)

5. email

6. Staff/student Classification*
classification Undergrad Grad student Postdoctoral Faculty Visiting Tech/serv A/P Staff none of these

7. Job title*

8. Supervisor   (use professor name if your are in a research group) (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. yes no does not apply not answered
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. yes no does not apply not answered
the location and availability of the Purdue CHP.	11. yes no does not apply not answered
the location and availability of safety information.	12. yes no does not apply not answered
the signs and symptoms of exposures to the hazardous chemicals used in my workplace.	13. yes no does not apply not answered
the Permissible Exposure Limits for the hazardous chemicals used in my workplace.	14. yes no does not apply not answered
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. yes no does not apply not answered
physical and health hazards of the hazardous chemicals in my workplace	16. yes no does not apply not answered
measures I can take to protect themselves from these hazards	17. yes no does not apply not answered
the details of the Purdue Chemical Hygiene Plan which apply to my workplace.	18. yes no does not apply not answered
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. yes no does not apply not answered

*Staff classification and job title.

Many part time and student employees do not know their staff classification, and that's fine and something we can work around.  Many of the "regular" employees can find their job title by looking up their own name in the MailHub directory at http://directory.purdue.edu/ph-query.html

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 fo rthe 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.