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Waggoner & Associates

Annual Refresher Training Acknowledgement/Receipt Form

Check Box Indicating Topic Covered In Training *

- - - Annual Radiation Safety Refresher Training

Part 37
Review of Training Requirements
Changes in RSP
Audit Results
Security

Check Box Indicating Topic Covered In Training *

- - - DOT HazMat Training covering general awareness, function specific, safety, driver, security awareness and in-depth security

Check Box Indicating Topic Covered In Training *

- - - Occupational Safety Training:

Accident / Incident Investigation
Bloodborne Pathogens
Defensive Driving
Electrical Safety – Unqualified
Fall Protection Competent Person; Certification Record IAW 1926.503(b)
Fire Extinguisher
First Aid
GFCI
HazCom including GHS info on SDS, Labels and Pictograms
Hearing Conservation
Heat Stress
Ladder Safety
Lockout / Tagout / Try
Personal Protective Equipment – PPE
Confined Space / PRCS including H2S
Respiratory Protection
Rigging
Scaffold Safety
Hand and Power Tools
Trench and Excavation Safety

I acknowledge by signing this form, that I have reviewed, in its entirety, the annual refresher training done through Zoom Meetings for the 2021 calendar year. I have undergone training in the categories listed above, and give permission to Waggoner & Associates, Inc. to use my signature on this form in place of each of the individual sign in sheets for every topic presented.

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Date *

Training Conducted By: *

Full Name *

Film Badge *

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