OSHA Form 4-50.11 OTIEC Outreach Program Monthly Report

OTIEC

Date Activity Initiated

Date Activity Completed

Basis for Monitoring Activity

Type of Monitoring Activity

Number of Classes included in Records Audit

Training Observation Class Type

Training Observation - Hours Observed

Trainer (Last Name)

Trainer (First Name)

City

ST

Result

Comments / Follow-up Resolution

see burden box below

Paperwork Reduction Act Statement

OMB Control Number: 1218-0262 Expiration Date: XXX 2023

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 1 hour per response, including time for reviewing instructions, searching for existing data sources, gathering and maintaining the data need, and completing and reviewing the collection of information. The obligation to respond to this collection is required for OTI Education centers to maintain OSHA's approval. The information is used to track performance measures and targets. OSHA provides no assurance of confidentiality on data collected on the Course Summary Report. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Occupational Safety and Health Administration, Directorate of Standards and Guidance, 200 Constitution Avenue, NW, Room N3718, Washington, DC 20210 and reference the OMB Control Number. Note: Please do not return the completed OSHA Form 4-50.11 to this address.

OSHA Form 4-50.11 (July 2017)