UNIVERSITY OF MINNESOTA

LABORATORY SAFETY STANDARD (29 CFR 1910.1450)

TRAINING RECORD

Employee Name_______________________________________________________________________________

Job Title________________________________________________________   Class Number____________

Department Name_____________________________________________________________________________

Department Address__________________________________________________________________________

Name of Trainer ______________________________   Job Title of Trainer_______________________

Qualifications of Trainer___________________________________________________________________

                              Subjects                                  Date of Training

Information:
· The contents, location and availability of the Laboratory             ____________________
  Safety Standard and its appendices
· The contents, location and availability of the Lab Safety Plan  ____________________
· Permissible Exposure Limits                                           ____________________
· Signs and symptoms associated with exposures to the chemicals in the  ____________________
  laboratory                                                              
· The location and availability of known reference materials            ____________________
  (e.g. MSDSs etc.) 

Training:		
· Methods and observations to detect the presence or release of         ____________________
  chemicals in the laboratory
· The physical and health hazards of chemicals in the laboratory        ____________________
· Measures employees can take to protect themselves from exposure to    ____________________
  chemicals in the laboratory
· Applicable details of the Lab Safety Plan, including general    ____________________ 
  and laboratory-specific Standard Operating Procedures
		
Other topics:		
___________________________________________________________________     ____________________

___________________________________________________________________     ____________________
		
___________________________________________________________________     ____________________
		
___________________________________________________________________     ____________________
		
___________________________________________________________________     ____________________

CERTIFICATION

The training record provided above is correct as of this date.

Employee
Signature_________________________________________________________   Date___________________	
                               (Print name above)
Supervisor
Signature_________________________________________________________   Date___________________	
                               (Print name above)
Bus Adm Form ### - Rev 3/94
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