Lab Specific Training Form
(Please use separate form for additional supervisors)
Name________________________________MTU. #____________________
Position______________________________Supervisor_________________
1. Topics Addressed by Laboratory Supervisor
a. Introduction to operations where chemical and physical hazards are
b.
c.
d.
e.
f.
g.
present/types of hazards encountered.
Required work practices
PPE
Emergency procedures
Detection of chemical hazards
Location and training on SOP(s), MSDS(s), and CHP
Labeling system
2. Training Provided (Place mark next to room number and name indicating
training supplied for this space.)
Dow:
106
107
109
110
201A
810
816
817
Dr. Hand
R. Fritz
D. Perram
D. Perram
Dr. Hand
Dr. Auer
Dr. Auer
Dr. Auer
822
826
827
833
835
838
839
845
Dillman
SB
B003
B004
B004A
B005
B006
Dr. Vitoon
Dr. Vitton
J. Vivian
J. Vivian
J. Vivian
R. Fritz
B008
B008B
B009
B009A
B010A
B010B
M&M
714
715
J. Anzalone
J. Anzalone
716
717
J. Anzalone
Dr. Urban
D. Perram
Dr. Hand
Dr. Perlinger
Dr. Hand
Dr. Seagren
Dr. Perlinger
R. Fritz
Dr. Ahlborn
J. Vivian
J. Vivian
Dr. Vitton
Dr. Vitton
J. Anzalone
J. Anzalone
850
850A
858
860
901
902
903
Dr. Becker
Dr. Becker
Dr. Urban
Dr. Auer
Dr. Doskey
Dr. Doskey
Dr. Doskey
B011
106
109
109A
110
314
Dr. Hodek
J. Vivian
Dr. Ahlborn
Dr. Swartz
Dr. Barkdoll
Dr. You
U112
M. Yokie
Lab Supervisor Signature____________________________Date___________
Employee Signature________________________________Date___________
(Signatures acknowledge that the above topics have been adequately communicated)