** append any additional forms, including EHS safety training certificates November 2017
PROCEDURE: This form must be completed for all individuals working in laboratories (i.e., employees, students,
visiting scientists, volunteers engaged in research, and teaching assistants). The safety training record is to be
updated on an ongoing basis as new training is provided. Training activities may be delegated to a qualified individual,
however, the supervisor ultimately is responsible and must ensure that this record is updated. This training record
may only apply to a specific location and additional training may be required for new labs and equipment. The
form must be filed in a binder marked “Safety” and housed in a visible location in the lab.
Email Address:
Supervisor Name:
Start Date:
Supervisor (or designate): I have specified the required training as indicated by checking the appropriate boxes
below: Supervisor Initials/Date Lab Personnel Initials/Date Complete
WHMIS _______________________ ___________________________
EHS Biosafety _______________________ ___________________________
Laboratory Safety _______________________ ___________________________
EHS Worker Health & Safety Awareness_____________________ ___________________________
First Aid / CPR _______________________ ___________________________
Radiation Safety _______________________ ___________________________
Transportation of Dangerous Goods _______________________ ___________________________
Animal Care _______________________ ___________________________
Other _______________________ _______________________ ___________________________
Lab Personnel: I have completed training on the equipment specified by my supervisor, as indicated below:
Both the supervisor and lab personnel are to initial and date upon completion of training on each piece of equipment.
Equipment Supervisor Initials/Date Lab Personnel Initials/Date Completed
Autoclave _______________________ ___________________________
Centrifuge _______________________ ___________________________
Compressed Gas _______________________ ___________________________
Electrophoresis _______________________ ___________________________
French Press _______________________ ___________________________
Laminar Flow Hood _______________________ ___________________________
Liquid Nitrogen _______________________ ___________________________
Microscopes _______________________ ___________________________
Microtome _______________________ ___________________________
Shaker _______________________ ___________________________
Other _______________________ _______________________ ___________________________
Other _______________________ _______________________ ___________________________
FIELD SAFETY (as applicable):
Lab Personnel:
I am aware of the hazards associated with the field work I will be performing and understand the
precautionary measures in place to protect my safety
I have reviewed the field work safety plan
Initials and Date: _________________________________
Supervisor (or designate):
I have completed a relevant field work safety plan and have reviewed it with the individual
I have ensured that the individual has provided the department with emergency contact information
Initials and Date: _________________________________
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