Hazard Communication/GHS Training Program – Training Record Form

This form is to intended to provide companies that have utilized the Non-Ferrous Founders’ Society (NFFS) HazCom/GHS training programs (www.nffs.org/ghs) to record the training provided to its employees. This form and attendance roster can be used as documentation of your GHS training for your employees.

This form is also intended to provide companies that have utilized the Non-Ferrous Founders’ Society (NFFS) HazCom/GHS training programs (www.nffs.org/ghs) an easy way to report their training program data back to NFFS. This data will be used by NFFS to demonstrate the effectiveness of the training materials to OSHA, and to provide a measure on the TOTAL number of industry employees trained using these materials.

PLEASE NOTE: NFFS WILL NOT provide the name of your facility to OSHA! NFFS will only report the number of employees trained, the total amount of time spent conducting the training, and the pre- and post- training examination scores. This data is important to help NFFS demonstrate the effectiveness of the developed training materials, and the DEMAND for similar types of training materials for the non-ferrous foundry industry. This can help NFFS secure future OSHA funding for training programs to assist foundries with other Occupational Safety and Health Topics.

Please complete all sections below. (Company Name is optional). Please fax this form to 847/299-3598 or email to [email protected]. You may contact NFFS at (847) 299-0950 if you would prefer to provide your training results verbally or if you have any questions.

Organization Name: ______

Location (City, State): ______

Date of Training: ______

Modules Presented:

[ ] Module 1: OSHA Worker’s Rights (15 Minutes) [ ] Module 2: GHS/HazCom and the Non-Ferrous Foundry (15 Minutes) [ ] Module 3: Safety Data Sheets (15 Minutes) [ ] Module 4: Labels (15 Minutes) [ ] Module 5: Air contaminants in the Non-Ferrous Foundry (30 Minutes) [ ] Module 6: Aluminum Foundries (30 Minutes) [ ] Module 7: Brass and Bronze Foundries (30 Minutes)

Total Duration of Training for all presented Modules: ______(minutes) (Sum of time for each module presented) x (number of employees trained)

Pre-Examination Average Score: ______% (Please provide the average pre-examination score for employees PRIOR to the training)

Post-Examination Average Score: ______% (Please provide the average post-examination score for employees AFTER the training) Employee Name (Please Print) Employee Signature