First Name Surname

Designation   Faculty Staff Graduate Undergraduate Staff/Student Number

Department

Phone NetID

Email

Supervisor

Courses will be offered on the following dates. All courses are 2 1/2 hours in duration. Please select  date of the course that you wish to attend from the drop down menu.

All courses will be held in the Faculty & Staff Learning Facility, Room B176 Mac-Corry Lecture Theatre

Course Date:  

The personal information on this form is collected under the authority of the Royal Charter of 1841, as amended. Upon successful completion of the course, personal information collected on this form will be used to generate training records and could be shared with the Departmental Safety Officer. If you have any questions or concerns about the information collected or how it will be used please contact the Environmental Health & Safety Department, Rideau Building, Room 326 by telephone at 613-533-2999.