Laboratory Safety Certificate Course Completion Form

Instructions & Information: Laboratory Safety Certificate Course Completion Form

Application
To apply for a certificate, fill out the following Laboratory Safety Certificate Course Completion Form with your information and the dates the courses were completed. A certificate will be issued after course completion has been verified in the EH&S database. All courses must be completed within five years of the submission date.

Course Listings
See the following Laboratory Safety Certificate Course Completion Form. Additional optional courses may be added in the future, so check for updates. PLEASE NOTE: Specialized departmental trainings can be used as an optional course. Examples of this trainings are: CARE Modules for Animal Research; NYS WPS training for Greenhouse Workers; DOT Chemical Shipping and OSHA 10 courses. If you have a required training you would like to have EHS consider as a listed course on your certificate, please send the information to “askEHS” at: www.ehs.cornell.edu/askEHS .

Courses Format
Live = Live classes. (See CU Learn for upcoming classes or click on the table).
On-line courses. (See CU Learn for Environmental Health and Safety on-line courses). To schedule a class for your group, contact “askEHS” at: www.ehs.cornell.edu/askEHS .

Submit the Completed Form to:
Agnes Morris, CAP
Environmental Health & Safety
395 Pine Tree Road, Suite 210
East Hill Office Building
Ithaca, NY, 14850

Questions?

Contact “askEHS” at: www.ehs.cornell.edu/askEHS | Approved by: Brenda Coolbaugh
Last revised by: Ed Evans | RSS_LSC_Lab_Certificate_Form |

	Laboratory Safety Certificate Course Completion Form

Submission Date:

Campus Phone:

Name:

Department:

NetID:

Campus Address:

Check one: Staff ☐ Faculty ☐ Undergraduate ☐ Graduate Student ☐ Other ☐

Required Courses (must complete all 10)	Live	Online	Date Completed
(1475) Chemical Segregation and Storage		×
(2716) Chemical Waste Disposal		×
(2394) Cleaning Up Small Lab Spills		×
(3355) Fume Hood Use & Energy Conservation		×
(2343) Hazard Communication		×
(2414) Laboratory Inspections		×
(2555) Laboratory Safety		×
(1071) Security of Hazardous Research Materials		×
(3915) DOT Hazardous Materials IATA General Awareness		×
(1776) How to Write Standard Operating Procedures		×

Approved by: Brenda Coolbaugh Last revised by: Ed Evans

RSS_LSC_Lab_Certificate_Form

	Laboratory Safety Certificate Course Completion Form

Optional Courses (choose 10 from the list)		Live	Online	Date Completed
(1074) Integrated Lab and Initial Biosafety (Not available after August 2015)		×
(3815) Carcinogen Safety			×
(2330) Centrifuge Safety			×
(2335) Compressed Gas Safety			×
(3835) Corrosive Safety			×
(3055) Cryogen Safety			×
(5330) Fire Safety			×
(3995) Flammable LiquidSafety			×
(2341) Formaldehyde Awareness		×	×
(2407) Hearing Conservation		×	×
(2348) Hydrofluoric Acid Safety			×
(2397) Laser Safety		×	×
(3435) N95 Respirator Training			×
(2347) Personal Protective Equipment		×	×
(2344) Radiation Safety/Users of Radioactive Material Day 1		×
(2675) Office Worker Safety			×
*Specialized Departmental Trainings*
Course Name:
Course Name:

Approved by: Brenda Coolbaugh Last revised by: Ed Evans

RSS_LSC_Lab_Certificate_Form

-- LeeShelp - 24 Apr 2017