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Tuesday, May 10, 2022 - Developing an Effective COVID-19 Prevention Plan- Registration Form
Complete this form to register for a COVID-19 Prevention Plan workshop.
Questions? Contact Maria Pritchard at
mmp1998@berkeley.edu
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* Indicates required question
Email
*
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Name of your Store/Business
*
Your answer
Your Job Title
*
Your answer
Preferred Contact Phone Number
*
Your answer
Store/Business Address
*
Your answer
City, State, and Zip Code
*
Your answer
Are you the designated person responsible for worker health and safety at your store/business?
*
Yes
No
If NO, is there such a person?
Your answer
If Yes, are you the designated person responsible for worker health and safety for more than one store/business?
Yes
No
Clear selection
Approximately how many people work in your store/business? *
*
1-5
6-10
11-20
21-50
51-75
76-150
151-250
250+
What language(s) do your employees speak?
*
English
Spanish
Chinese (Mandarin/Cantonese)
Other:
Is your store/business represented by a union?
*
Yes
No
If Yes, which union?
Your answer
Please list any employer organizations or associations your store/business is affiliated with.
*
Your answer
What motivated you to attend this training?
*
Your answer
Have you attended any other workplace health and safety training sessions in the past 5 years?
*
No, 0 Trainings
Yes, 1-2 Trainings
Yes, 3+ Trainings
Not Sure
How did you hear about this training?
*
Your answer
What questions are you hoping to get answered during the course?
*
Your answer
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