Laboratory Safety Certificate Course Completion Form Form Laboratory Safety 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 EHS 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: Other EHS trainings not listed below and 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; 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”: This certificate is specific to Cornell University faculty, staff, and students and may not be applicable outside of Cornell University. Courses Format Live = Live classes. On-line courses. (See CU Learn for Environmental Health and Safety on-line courses). To schedule a class for your group, contact “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” Approved by: Brenda Coolbaugh Last revised by: Michelle Yung Revision date: 01/31/19 RSS_LSC_Lab_Certificate_Form The most recent version of this document is available electronically at EHS’ website: Page 1 of 3 https://sp.ehs.cornell.edu/lab-research-safety/chemical-safety/lab-safety-certificate-program/Documents/RSS_LSC_Lab_Certificate_Form_IPDF.pdf Laboratory Safety Certificate Course Completion Form Form Laboratory Safety Submission Date: Name: Campus Phone: Department: NetID: Campus Address: Check one: Staff ☐ Faculty ☐ Undergraduate ☐ Required Courses Live Graduate Student ☐ Online Other ☐ Date Completed (must complete all 10) (2555) Laboratory Safety (2716) Chemical Waste Disposal (2394) Cleaning Up Small Lab Spills (1475) Chemical Segregation and Storage (1071) Security of Hazardous Materials Used in Research (2414) Laboratory Inspections (1776) How to Write Standard Operating Procedures (3355) Fume Hood Safety and Energy Conservation (5330) Fire Safety (1333) DOT Hazardous Materials Transportation – Materials of Trade Approved by: Brenda Coolbaugh Last revised by: Michelle Yung Revision date: 01/31/19 RSS_LSC_Lab_Certificate_Form Page 2 of 3 The most recent version of this document is available electronically at EHS’ website: https://sp.ehs.cornell.edu/lab-research-safety/chemical-safety/lab-safety-certificate-program/Documents/RSS_LSC_Lab_Certificate_Form_IPDF.pdf Laboratory Safety Certificate Course Completion Form Form Laboratory Safety Optional Courses (choose 10 from the list) (1070) Bloodborne Pathogens Certification Live Online (3815) Carcinogen Safety (2330) Centrifuge Rotor Safety (2335) Compressed Gas Safety (3835) Corrosive Chemical Safety (3055) Cryogen Safety (4336) Electrical Safe Work Practices (3995) Flammable Liquid Safety (2341) Formaldehyde Awareness (5170) Glassware Washing Safety (2407) Hearing Conservation (2574) Pyrophorics (2342) Radiation Safety Awareness (5035) Magnetic Field Safety (2347) Personal Protective Equipment (2348) Hydrofluoric Acid Safety (2397) Laser Safety Date Completed Specialized Departmental Trainings Course Name: Course Name: Course Name: Course Name: Approved by: Brenda Coolbaugh Last revised by: Michelle Yung Revision date: 01/31/19 RSS_LSC_Lab_Certificate_Form Page 3 of 3 The most recent version of this document is available electronically at EHS’ website: https://sp.ehs.cornell.edu/lab-research-safety/chemical-safety/lab-safety-certificate-program/Documents/RSS_LSC_Lab_Certificate_Form_IPDF.pdf
