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* REQUIRED |
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* Trainer Program Authorizations |
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| OTIEC* |
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Mailing Address* |
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General Industry |
Construction |
Maritime |
Disaster Site |
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| OTIEC Prefix* |
Name Prefix |
*Last Name |
*First Name |
MI |
Name Suffix |
Address1 |
Address2 |
Address3 |
City |
State |
ZipCode |
Phone |
*Email Address |
Card # |
Date Issued |
Card # |
Date Issued |
Card # |
Date Issued |
Card # |
Date Issued |
ET&Dinfo |
CalOSHA |
| see burden box below |
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Paperwork Reduction Act Statement |
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OMB Control Number: 1218-0262
Expiration Date: XXX 2023 |
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According to the Paperwork Reduction Act of 1995, no persons are required to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estiamated 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 information is used to used to maintain a database of all OSHA authorized Outreach Training Program trainers. This form is completed monthly by the OTI Education Centers after completion an Outreach train the trainer course. Information provided is those students who have successfully completed the course. 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 to this address. |
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OSHA Form
(July 2017) |
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| OTIEC |
OTIEC Abbreviation |
OTIEC Prefix per OTIEC |
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OTIEC Prefix in Numeric Order |
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| Atlantic OSHA Training Center |
AOTC |
12 |
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11 |
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| Arizona State University |
ASU |
40 |
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12 |
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| Chabot-Las Positas Community College |
CHABOT |
32 |
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13 |
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| California State University of Dominguez Hills |
CSUDH |
31 |
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14 |
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| Eastern Kentucky University |
EKU |
16 |
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15 |
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| Florida State College at Jacksonville |
FSC |
37 |
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16 |
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| Great Lakes Regional OTI Education Center |
GLAKE |
21 |
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17 |
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| Georgia Tech Research Institute |
GT |
17 |
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18 |
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| Keene State College |
KEENE |
11 |
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19 |
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| Metropolitan Community College |
MCC |
27 |
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20 |
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| Mid-America OTI Education Center |
MIDAM |
23 |
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21 |
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| Mid-Atlantic OSHA Training Institute |
MIDATL |
14 |
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23 |
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| Midwest OSHA Education Center |
MOEC |
28 |
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24 |
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| Mid-South OTI Education Center |
MSOUTH |
39 |
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25 |
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| Mountain West OSHA Education Center |
MTWEST |
29 |
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26 |
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| National Resource Center |
NRC |
15 |
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27 |
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| National Safety Education Center |
NSEC |
24 |
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28 |
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| Rochester Institute of Technology |
RIT |
13 |
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29 |
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| Rocky Mountain Education Center (Red Rocks) |
RM |
30 |
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30 |
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| Southeastern OTI Education Center |
SE |
18 |
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31 |
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| Texas Engineering Extension Service |
TEEX |
25 |
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32 |
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| University of Alabama |
UA |
19 |
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34 |
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| University of California San Diego |
UCSD |
34 |
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35 |
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| University of South Florida |
USF |
20 |
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37 |
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| University of Texas at Arlington |
UTA |
26 |
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38 |
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| University of Washington |
UW |
35 |
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39 |
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| Volunteer State Community College |
VOL |
38 |
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40 |
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