June 4 and 6, 2024 SASH Registration Form
*Promoting Safe and Healthy Workplaces for California's School Employees*
This online training for School District employees and other partners in school safety and health is FREE for all participants.

Please complete this form to register for a SASH workshop.
Questions? Contact Liam Chavez lmchavez4@berkeley.edu
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Email *
Training Date you would like to attend: *
Registrant Information
First Name and Last Name *
Please enter your name as you'd like it to appear on your certificate of completion.
Preferred Name: *
Preferred email address: *
Is this your work email? *
Direct phone number:  (xxx-xx-xxxx) *
Is this your work phone? *
Do you require any accommodations in order to participate in this course? If so, please elaborate.
 *
In order to participate, you will need access to a computer with a working microphone and camera. You should also have Zoom installed as well as a web browser (such as Google Chrome or Mozilla Firefox). Do you have access to these?
 *
Do you consent to us taking your picture for use in LOHP's social media? (You are not obligated to do so and may still participate if you decline)
 *
Employer: *
Is your employer a: *
What county do you work in? *
If you work for a school or school district, what department do you work in?
Clear selection
Your Job Title/ Position *
What language(s) do you speak at home? (Check all that apply) *
Required
Have you attended any prior health and safety training lasting more than 2 hours: *
Required
Are you a member of a union? *
If Yes, which union?
If Yes, do you have a leadership role?
Is there a health and safety committee that includes a focus on employee health and safety? *
Are you responsible for carrying out health and safety activities in your district?
Clear selection
Are you responsible for writing your district's Injury and Illness Prevention Plan? *
Are you responsible for writing your district's COVID-19 Protection plan? *
A copy of your responses will be emailed to the address you provided.
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