UNIVERSITY OF MINNESOTA

LABORATORY SAFETY STANDARD (29 CFR 1910.1450)

TRAINING RECORD

Employee Name_______________________________________________________________________________

Job Title________________________________________________________ Class Number____________

Department Name_____________________________________________________________________________

Department Address__________________________________________________________________________

Name of Trainer ______________________________ Job Title of Trainer_______________________

Qualifications of Trainer___________________________________________________________________


Subjects Date of Training
Information:
· The contents, location and availability of the Laboratory ____________________
Safety Standard and its appendices
· The contents, location and availability of the Lab Safety Plan ____________________
· Permissible Exposure Limits ____________________
· Signs and symptoms associated with exposures to the chemicals in the ____________________
laboratory
· The location and availability of known reference materials ____________________
(e.g. MSDSs etc.)

Training:
· Methods and observations to detect the presence or release of ____________________
chemicals in the laboratory
· The physical and health hazards of chemicals in the laboratory ____________________
· Measures employees can take to protect themselves from exposure to ____________________
chemicals in the laboratory
· Applicable details of the Lab Safety Plan, including general ____________________
and laboratory-specific Standard Operating Procedures

Other topics:
___________________________________________________________________ ____________________

___________________________________________________________________ ____________________

___________________________________________________________________ ____________________

___________________________________________________________________ ____________________

___________________________________________________________________ ____________________

CERTIFICATION

The training record provided above is correct as of this date.

Employee
Signature_________________________________________________________ Date___________________
(Print name above)
Supervisor
Signature_________________________________________________________ Date___________________
(Print name above)
Rev 5/04