Environmental Health & Safety Training Profile by 39moJsW

VIEWS: 5 PAGES: 4

									                   CENTRE FOR ENVIRONMENTAL HEALTH AND SAFETY MANAGEMENT

                               EHS ORIENTATION PROGRAM

          Environmental Health & Safety Competency Screening Form
    for ALL Students participating in Medium to High Risk Academic Activities

Process:

   Form to be distributed to ALL students participating in medium to high risk academic
    activities such as those using machine shops, working in laboratories or working in research
    facilities

   Form to be reviewed by the Faculty Member and signed off

   Completed Form submitted to the Chair/Academic Director at the beginning of each term

   A summary of the information is then provided to the Centre for Environmental Health &
    Safety Management within 1 month of the new term starting.




Student Name (Print): __________________________________________________________



Date: ______________________       Email: __________________________________________




Faculty/Instructor Member: ____________________________________________________

Email:                        ____________________________________________________

Building/Office:              ____________________________________________________

Tel # or Extension:           ____________________________________________________

Lab(s)/shop(s):               ____________________________________________________




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     Please look for your Faculty and check off the appropriate boxes.


Faculty of            Level                      Program                           Year
                          PhD                       Aerospace Engineering                 1
Engineering               Masters                   Architecture                          2
& Applied                 Undergraduate             Biology                               3
Science                                             Chemical Engineering                  4
                       Continuing Education         Chemistry
                         …Course                    Civil Engineering
                         …Certificate               Contemporary Science
                                                    Electrical Engineering
                                                    Industrial Engineering
                                                    Mechanical Engineering




Faculty of            Level                      Program                           Year
                          PhD                       Fashion                               1
Communication             Masters                   Graphic Comm Mgmt                     2
& Design                  Undergraduate             Image Arts                            3
                                                    Interior Design                       4
                       Continuing Education         Theatre
                         …Course
                         …Certificate




Faculty of            Level                      Program                           Year
                          PhD                       Nutrition                             1
Community                 Masters                   Midwifery                             2
Services                  Undergraduate             Nursing                               3
                                                    Occupational & Public Health          4
                       Continuing Education
                         …Course
                         …Certificate




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  Applies
                                              Hazardous Activity
(Yes/No/NA)

                Working with or in close proximity to hazardous materials including chemicals,
                noise, radiation, or biohazards.

                If yes, a WHMIS certificate is required

                Working in a laboratory with chemicals, radiation, or biohazards.

                If yes, LABORATORY SAFETY is required.
                If yes, a WHMIS certificate is required
                If yes, Lab Specific Training is required to be provided by the supervisor or their
                designate

                Working in a shop (machines/equipment/lubricants/oils).

                If yes, SHOP SAFETY is required.
                If yes, WHMIS is required

                Will you be required to use any personal protective equipment?

                If yes, training on that equipment is required.




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Mandatory Training Requirements:

Based on the information provided and any other relevant assessment made by the Faculty
member, please list the Health & Safety training to be completed by the student:

                Course/
                                           Obtained By:          Date to Complete   Completed
          Information Session
1       OHS Orientation             * CD available in Library

2       WHMIS                       * Available on-line

3

4
5

6

         http://www.ryerson.ca/cehsm/orientation/index.htm
         http://www.ryerson.ca/cehsm/training/whmis/index.htm



Signature of Student: _____________________________________            Date: _______________



Signature of Faculty Member: ______________________________            Date: _______________



Name of Chair/Academic Director: _________________________________________________



Signature of Chair/Academic Director: _______________________ Date: _______________



Resources:

Cate Drum, EHS Officer, cdrum@ryerson.ca or 7086
Liz Krivonosov, RBC Safety Officer, ekrivono@ryerson.ca or 4212
Departmental Safety Officers and/or Technicians/Technologists/Technical Officers




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