U.S. DEPARTMENT OF LABOR
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
FORM APPROVED
OMB NO. 1218-0262
Expiration: 10/31/2013
OUTREACH TRAINING PROGRAM REPORT
CONSTRUCTION
Submit completed forms to:
UCSD/OSHA Training Outreach Coordinator 404 Camino del Rio South #102 San Diego, CA 92108-3586
Phone: 800-358-9206
NOT FOR SUBMISSION
1.
Trainer Name Remedios Ramirez
2.
ID No. U05201026
3.
Recent Trainer Course #502 - Update for Construction Industry
4.
Expiration Date 12/01/2025
5.
Authorizing Training OrganizationUC San Diego Extended Studies - OSHA Training Institute
6.
Trainer Address
Company
Alliant Insurance Services
Address
31449 Rivera St.
CityWinchester
StateCA
Zip92596
Phone No.
951-202-9014
Emailramirezreme4@gmail.com
7. Course Conducted
10-hour
30-hour
8. Course Information (check all that apply)
Spanish
Language other than English or Spanish (specify):
Youth (age 18 or less)
OSHA Alliance or Partnership (specify):
9. No. of Students
26
10. Training Site Address
Street address530 Technology Dr.
CityIrvine
CA
Country USA
11. Type of Training Site
Workplace
School
Office
Hotel
Union
Employer Association
Other (specify):
12. Course Duration
Start Time
9:00 AM
End Time
3:30 PM
Start Time
8:00 AM
End Time
2:30 PM
Start Time
9:00 AM
End Time
3:30 PM
Start Time
8:00 AM
End Time
2:30 PM
Course Date
09/16/2021
Course Date
09/23/2021
Course Date
10/01/2021
Course Date
10/07/2021
13. Sponsoring Organization
Safety & Health
Employer
Labor/Union
Employer Association
Education
Community
N/A
Other (specify)
14. Statement of Certification I certify that I have conducted this outreach training class in accordance
with the OSHA Outreach Training Program guidelines. I have maintained the
training records as required by these guidelines and I will provide these
records to the OSHA Directorate of Training and Education (or their designee)
upon request. I understand that I will be subject to immediate dismissal
from the OSHA Outreach Training Program if information provided herein is
not true and correct. I further understand that providing false information
herein may subject me to civil and criminal penalties under Federal law,
including 18 U.S.C. 1001 and section 17(g) of the Occupational Safety and
Health Act, 29 U.S.C.666(g), which provides criminal penalties for making
false statements or representations in any document filed pursuant to that
Act. I hereby attest that all provided is true and correct.
Trainer Signature:
Date:
If submitting this form by electronic means, by checking the box to
the left or affixing signature, I attest that all information provided in
this submission is true and accurate.
15. Topic Outline
10-Hour Topics
*Indicate the amount of time spent on each of the topics in
the class.
REQUIRED
Hours *
1.00
Introduction to OSHA
4.00
OSHA Focus Four Hazards - note the total time spent on the line to the left, and indicate the time breakdown on each line below:
2.00Falls
1.00Electrocution
.50Struck By
.50Caught-In or Between
.50
Personal Protective Equipment
.50
Health Hazards in Construction
ELECTIVE
Cranes, Derricks, Hoists, Elevators, and Conveyors
