LOSH 8-HR HAZWOPER Training Registration
Please begin your enrollment by completing and submitting the form below. After submission, you will be contacted via email regarding next steps.

Note: To be added to the roster, students must enroll at least 3 business days before the training date.

Training registration will close when class enrollment is full (Max. 15 trainees).

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Training Agency
Location
Name of Course
Date  *
First Name *
Last Name *
Middle Initial
Date of Birth
mm/dd
City *
State *
ZIP *
Home Phone # *
Home Email Address *
Payment Method *
Due to COVID-19, we highly encourage CARD payments. Check payments are still accepted, however your certification may be delayed due to late-check arrivals.
Contact for Payment (if different, please provide name, email & phone number)
Are you currently employed? *
SECTION A - WORKPLACE INFORMATION
Note: if you are currently employed, please complete SECTION A. If not, skip to SECTION C - Information About You
Name of Employer
Employer Address
City (Employer)
State (Employer)
ZIP (Employer)
Work Phone #
Work Email Address
What is your job title?
Please do not use abbreviations.
What type of employer do you work for?
Batalkan pilihan
Do you belong to a union?
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If you belong to a union, please provide Union and Local
What best describes the type of industry where you work? *
Please check ONE only. If working as a consultant or inspector, choose the item that best describes your clients' or inspection industry.
Can we contact you in 6 months with a few short questions about how this training has been useful?
Batalkan pilihan
Best email address to reach you: 
SECTION B - WORKSITE HAZMAT ACTIVITIES
What best describes the type of hazardous waste/HAZMAT operations at your worksite?  *
If working as a consultant or inspector, choose the item that best describes your clients' or inspection sites.
Wajib diisi
What will be your routine job duties in the next 12 months? *
Wajib diisi
SECTION C - INFORMATION ABOUT YOU
Our funders (NIEHS) have asked us to gather more information about the people we train so they can learn more about hazardous workers. We would appreciate your answers to the following questions:
Gender
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What language do you speak at home?
What is your ethnic/racial background?
If multiple, please indicate the one you would prefer to report:
What is your age?
What is the highest level of education you have completed?
When did you last take your 40-HR training? (mm/yy) *
How did you hear about our training? *
In your job, do you wear any type of personal protective equipment? If so, what type?
Have you taken 40-Hr HAZWOPER or Refresher training with LOSH before?
Batalkan pilihan
Berikutnya
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