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UNIVERSITY OF THE PACIFICI Risk Management Training Form STOCKTON, CA 3ubjeot: CHP,IIPP;HMW,lab safety,WPV and related topics Dresenter.Ash Chaudhry Date:January 27,2011 Time in training: ....... .. min PLEASE PRINT NAME SIGNATURE JOB TITLE DEPT 1xeaearcher o TA a Professor oAdmin oEng A Chem a PHS 2yYResearcher o TA o Professor oAdmin aEng inCharn o PHS v L&w G /N�, 3 r- o Researcher o TA Professor oAdmin oEng o Chan HS l dl/L(y YIV) v� 4 Researcher o TA o Professor oAdmin oEng YChern o PHS � 01 rC4D �v 5 a Researcher o TA a Professor uAdmin oEng o Chem o PHS 6 o Researcher o TA o Professor oAdmin nEng ❑Cbm o PHS 7 o Researcher o TA o Professor nAdmin oEng o Chem o PHS g n Researcher o TA o Professor nAdmia oEng o Chem o PHS 9 o Researcher o TA o Professor uAdmin oEng o Chem o PHS 10 o Researcher a TA o Professor oAdmin uEng a Chan ❑PHS 11 ❑Researcher o TA o Professor oAdmin nEug ❑Chem o PHS 12 o Researcher a TA o Professor❑Admin oEng a Chem o PHS 13 o Researcher a TA o Professor oAdmin oEng o Chem a PHS 14 u Researcher o TA o Professor❑Admin nFog o Chem a PHS 15 ❑Researcher a TA o Professor oAdmin oEng o Chan o PHS 16 a Researcher ❑TA 0 Professor oAdmin oEng a Chem o PHS 17 ❑Researcher a TA a Professor oAdmin oEng o Chern o PHS 18 o Researcher o TA a Professor nAdmin oEng o Chan o PHS 19 o Researcher o TA a Professor oAdmin oEng o Chem n PHS 20 o Researcher a TA o Professor aAdmin oEng o Chem o PHS 21 a Researcher o TA o Professor oAdmin oEng o Chem a PHS I have anmided Pacifies Safety Refresher,lab safety protocols and read Annual Asbestos Letter. I understand it and am willing to comply with all that bas been discussed. If 1 have any question Page 1 of 3 Version 5.1 (Sep 2010) on any aspect of safely,1 will contact my Supervisor or Dept Chair or Risk Management or HR