Safety day registration form

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The ability to maintain a safe and secure workplace is essential to worker safety. This conference is designed to provide the resources and information to enhance safety through awareness, design, delivery and evaluation. Those attending will have an opportunity to hear from current OSHA enforcement Safety and Health Officers, local area OSHA office director, respected leaders and practitioners in the field today.

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Safety day registration form

  1. 1.   Fox Valley Technical College Safety Days Registration Form Register Today (all information is required): Organization Name: ______________________________________________ Contact Name & Title: ____________________________________________ Address: ____________________________________________________________ City, State, Zip: _____________________________________________________ Phone Number: ____________________________________________________ Email Address: _____________________________________________________ Billing: Participant Name: _________________________________________ ___ Check Enclosed Title: ________________________________________________________ ___ Bill my Organization Email: _______________________________________________________ *DOB: _______________________________________________________ ___ Purchase Order PO# __________________ Participant Name: __________________________________________ Title: _________________________________________________________ ___ Credit Card Email: ________________________________________________________ Call (920) 996‐2949 with card           *DOB: ________________________________________________________ information. Using a credit card will add 2.75% non‐refundable inance charge. Participant Name: ___________________________________________ Title: __________________________________________________________ Email: _________________________________________________________            *DOB: _________________________________________________________ Review the next page to make your Safety Days Conference selections Registration Contact: Email: sternhal@fvtc.edu PH: (920) 996‐2949 Fax: (920) 735‐4771
  2. 2.   Tuesday, January 8 Conference $29 class # 63681 9:00 AM ‐ 9:45 AM □ A. Work zone Safety □ B. Fall Arrest System 10:00 AM ‐10:45AM □ A. Effective Safety Committees □ B. Arc Flash 11:00 AM ‐ 11:45 AM □ A. Introduction to Accident Investigation □ B. Ergonomics w/ Back Injury 11:45 AM‐ 12:30 PM Lunch, time w/ Vendors 12:30 PM ‐ 1:15 PM □ A. Ripple Effects of Accidents □ B. LO/TO 1:30 PM ‐ 2:15 PM □ A. Haz Com/GHS □ B. Con ined Space 2:30 PM ‐ 3:15 PM □ A. Record Keeping □ B. Scissor/Aerial Lifts 3:30 PM ‐ 4:15 PM Lessons from Lambeau Field 4:15 PM– 4:30 PM Seminar Closing

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