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UNIVERSITY OF THE PACIFICI Risk Management Training Form STOCKTON, CA "subject: CHP,IIPP;H MIP,WPV,annual asbestos letter and related topics presenter:Ash Chaudhry Date: August 23, 2011 Time in training:60 min PLEASE PRINT NAME SIGNATURE JOB TrrLE DEPT 1 � ❑Researcher ❑TA o Professor teff ■Dental Clinics/Hygiene Use Ona 2 '' a Researcher o TA o Professor teff ■Dental Clinics/Hygiene �J.R.A,Y)n` SW 1 'F+ 3 f o Researcher o TA o Professor i6liae2tal C' " Hygiene q a Researcher o TA a ProfessorgStaff qPen Cfuo Hygiene S ct oaf W g a Researcher o TA a Professor tall ■ ygiene 6 o Researcher o TA)Professor aSteff ■Dental Clinics/Hygiene 7 o Researcher o TA a ProfessofyStaff tel msc ygiene g o Researcher a TA o Professor tufftal C" Hygiene 1LA121 WA t_wO 9 o Researcher a TA o Professor rWtaff Dental Clini Hygiene eta `Iia CGuA hl1 10N 'Iran o Researcher o TA o Professor tall Dental Clini Hygiene tA 1 t �� a Researcher a TA a Professor teff jant tini Hygiene 12 .n Researcher o TA a Professor■Staff cola mt ygiene a Researcher a TA o ProfessorASt ■Dental Clinics!Hy 13�j/9 14 a Researcher a TA➢(Professor oStaff ■Dental Clinic iene o Researcher a TA Professor oStaff ■Dental Clinic ygiene 16 l a Researcher a TAOlProfessor aStaff ■Dental Clini Hygiene 17 a Researcher o TA o Professor oStaff ■Dental Clinics/Hygiene lg a Researcher a TA o Professor oStaff ■Dental Clinics/Hygiene 19 a Researcher a TA a Professor cStaff ■Dental Clinics/Hygiene 20 a Researcher a TA a Professor oStaff ■Dental Clinics/Hygiene 21 a Researcher a TA o Professor oStaff ■Dental Clinics/Hygiene 22 0-Researcher a TA a Professor❑Staff ■Dental Clinics/Hygiene I have attended Pacifies Safety Refresher end read Annual Asbestos Letter. I understand R and am willing to comply with all that has been discussed. If I have any question on any aspect of Page 1 of t Varelon 5(August 2010) safety,I will contact my Supervisor or Dept Chair or Risk Menagement or HR