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Training Report

36-hour Safety Committee/Team Leader


To ensure timely processing of your order, please complete this training
report in English. If any required information is missing or incorrect, your
order may be delayed.
Email the completed training report to your OSHAcademy Training
Coordinator as a Microsoft Word document (.doc or .docx format only). Please
do not use PDF format for training reports.
Training reports should be submitted no later than 30 days after completion
of training. OSHAcademy will not accept training reports more than 90 days
after completion of training.
1. ATP Information
ATP Company Name:

Required

Primary Contact for


Order:

Required

Shipping Address:

Required Full Mailing Address

2. Trainer Information
Trainer Name(s):

Required

Authorized Trainer
Number(s):

Required

3. Training Information
Location Training was
Conducted:
List Dates Training was
Conducted
Number of Days Training was
Conducted
Classroom
Hours

Requir
ed

Required City and Country


Required List Individual Dates or a
Consecutive Date Range (Use MM/DD/YYYY
date format)
Required

Home-Study
Hours

Requir
ed

Total Hours

Require
d

PDF &

$40

4. Certificate Options (Choose ONE)


[

Each student will receive seven (7) course certificates,

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Training Report
36-hour Safety Committee/Team Leader
one (1) program certificate, one (1) wallet card, and one
(1) transcript.

Original

Best Value

Each student will receive one (1) program certificate, one


(1) wallet card, and one (1) transcript.

PDF &
Original

$35

Each student will receive seven (7) course certificates,


one (1) program certificate, one (1) wallet card, and one
(1) transcript.

PDF Only

$30

Please Note: Students completing online training courses must pay online fees.
Trainers may assist online students making payments.

5. Payment Method (Choose ONE)


[

Credit Card

Western Union or Money Gram - Send Your Payment Information To


OSHAcademy

OrderBay (Nigeria and Ghana only)

Bank Wire Transfer - Send Your Payment Information To OSHAcademy

Other: Enter Description

6. Special Instructions
Please provide any special instructions or notes in the box below.

7. Certification of Training
I, [ATP Representative Name], have completed a total of [ ## ] hours of
training, including time spent reviewing course material, engaging in
classroom discussion, and completing course exams.
Training was conducted in conformance with the terms of OSHAcademys
Authorized Training Provider Requirements and ATP Code of Professional
Conduct.
Students included on this training report have successfully completed the
courses and/or certificate program(s) listed below with at least a 70% score
on each required course exam.
I, [ATP Representative Name], certify this training report to be accurate and valid.
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Training Report
36-hour Safety Committee/Team Leader
OSHAcademy Office Use Only
Notes

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Training Report
36-hour Safety Committee/Team Leader
Use the table below to provide student numbers, names, and course completion dates. Student names will be displayed
on all documents exactly as provided on this training report. Significant name changes are not allowed once the
training report has been submitted. Please verify the student information you provide is accurate.
Important Note: If a student has completed OSHAcademy courses or programs previously, please include their

current OSHAcademy student number in the Returning Student # column.


Retur
ning
Stude
nt #

COURSE NUMBER

700

701

702

704

707

711

717

COURSE COMPLETION
DATE

MM/
DD

MM/
DD

MM/
DD

MM/
DD

MM/
DD

MM/
DD

MM/
DD

STUDENT NAME

Birth
Date

City of
Birth

1.
1
2.
2
3.
3
4.
4
5.
5
6.
6
7.
7
8.
8
9.
9
10.
1
11.
1

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12.
1
13.
STUDENT NAME

Birth
Date

City of
Birth

14.
1
15.
2
16.
3
17.
4
18.
5
19.
6
20.
7
21.
8
22.
9
23.
1
24.
1
25.
1
26.
27.
2

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36-hour Safety Committee/Team Leader
28.
3
29.
4
30.
5
31.
6
32.
7
STUDENT NAME

Birth
Date

City of
Birth

33.
1
34.
2
35.
3
36.
4
37.
5
38.
6
39.
7
40.
8
41.
9
42.
1
43.
1
44.
1

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36-hour Safety Committee/Team Leader

45.
46.
2
47.
3
48.
4
49.
5
50.
6

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