Registration Form SH Hazardous Energy Student Registration Form COURSE DATAHazardous Energy Control (LOTO) TrainingThis training is funded by a Susan Harwood Training Grant from the U.S. Department of Labor (Grant# SH-99019-SH0). All courses conducted virtually from Atlanta, Georgia.Course Date* Instructor(s) Name(s)*Neely BridgesKenneth DavisThomas DeanPaige RohrigPaul SchlumperRachel SchneiderSelect all instructors who took part in your training course.PERSONAL DATA & GEORGIA TECH DATALegal Last Name* Legal First Name* MI Gender* Male Female Job Title* Job Responsibilities*Email* Phone*Street Address* City* State* Zip* Address Type* Home Work Preferred First Name* EMPLOYER DATAName of Employer State Zip STUDENT GROUPS (mark “X” on appropriate line) Federal OSHA Personnel State OSHA Personnel Private Sector Personnel Other Federal Agency Personnel Other State or Municipal Personnel Foreign Student Signature Reset signature Signature locked. Reset to sign again Δ
