OSHA BLOODBORNE PATHOGEN TRAINING SESSION

TRAINING DATE _____________________________________

TRAINER ____________________________________________

PRINT YOUR NAME __________________________________

SIGN YOUR NAME ___________________________________

JOB TITLE __________________________________________

TELEPHONE EXTENSION______________________________

I, THE ABOVE SIGNED, RECEIVED ON THE ABOVE DATE THE FOLLOWING:

(Please INITIAL where appropriate.)

_____ OSHA INSERVICE ON BLOODBORNE PATHOGENS

_____ INSTRUCTION (VIA VIDEO) ON THE PROPER USE AND REMOVAL OF DISPOSABLE GLOVES.

_____ I HAVE RECEIVED OR ALREADY HAVE IN MY POSSESSION A PPE AND SPILLS KIT.

_____ I AGREE TO READ/REVIEW BY AUGUST 29, 2005 THE ON-LINE OSHA BLOODBORNE PATHOGEN TRAINING SESSION SUPPLEMENTAL MATERIALS. (Instructions are provided on the accompanying pink form, which I will sign and return upon completion of this task.)