Hospitality Health & Safety Manager Certificate Request | CSUDH CCPE

Hospitality Health & Safety Manager Certificate
Application Form

To earn the Hospitality Health and Safety Manager Certificate, participants must complete a total of ten (10) required courses and three (3) elective courses; at least four (4) courses must be completed through the CSUDH OTIEC.
All courses must be completed within five (5) years. The official certificate start date is determined by the first day of the first courses the participant wishes to count toward the certificate.

Courses taken through other official OSHA Training Institute Education Centers can be used to fulfill up to four (4) courses required for the certificate of completion if these courses were completed within two (2) years prior to the participant’s official certificate begin date at CSUDH OTIEC.
Proof (certificate/transcript) for any course taken at another center should be emailed to osha@csudh.edu titled "Certificate Request {student name}" when submitting a Certificate Request.

Student Information
*Full Name:	[Name as it should appear on the printed Certificate]
*Full Mailing Address:	[Include Street Address, City, State and Zip Code]
*Student ID:
*E-mail Address:
Contact Phone:

Courses (check all that apply)
Required Courses (Complete all 10 Courses):
OSX 995 \| Developing an Effective Hotel Safety Program OSX 995 \| Developing an Effective Restaurant Safety Program OSX 973 \| Introduction to Risk Management OSX 913b \| Effective Leadership Skills OSX 913a \| Effective Communication Skills OSX 913c \| Managing a Multi-Cultural Workforce OSX 913d \| Developing an Effective IIPP OSX 995 \| Developing a Musculoskeletal Injury Prevention Program OSX 971 \| OSHA 7505 Introduction to Incident (Accident) Investigation OSX 914 \| Cal/OSHA Legal Process
Elective Courses (Choose and Complete 3 Courses):
OSX 921 \| OSHA 521 - OSHA Guide to Industrial Hygiene OSX 958 \| OSHA 2255 - Principles of Ergonomics OSX 940 \| OSHA 5119 OSHA Standards for General Industry OSX 911 \| OSHA 511 OSHA Standards for General Industry OSX 913 \| Safety Audits and Inspections OSX 995 \| Workplace Violence Prevention OSX 985 \| OSHA 7200 Bloodborne Pathogens Exposure Control

Student Signature
Initials
Date