Training Company Name: _Name of Employer___________________________

Address: _________________________________________

Phone number: ____________________________________

Name of Trainer: __Name Manager_________________________________

HAZMAT EMPLOYEE TRAINING RECORD 

Employee Name: __John Doe____________________________

I certify that the hazmat employee identified on this training record has been trained and tested as required by the Hazardous Materials Regulations, Subpart H. 

Siqned:______________________________ 	Title: _____________________________

GENERAL AWARENESS / FAMILIARIZATION 
Description, Copy, and Location of Training	Training Provided By	Test / Score (not mandatory) 
	Date Trained	
Completed PHSMA on-line training modules. Completed certificate located in file in main office	Employer Training
Officer Jane Doe	Test attached to file: 98%	7/17/16	

FUNCTION SPECIFIC 
Description, Copy, and Location of Training	Training Provided By	Test / Score (not mandatory) 
	Date Trained	
DOT Hazardous Materials Transportation Training Modules 3 and 4: Packaging, Marking and Labeling
- Copy located in main office	Employer Training
Officer Jane Doe	Test attached to file: 100%	8/17/16	
Attended hand-on backhaul packaging training in Anchorage	Total Reclaim	See certificate of attendance 	9/17/16	
Performance Demonstration of Packaging, Marking and Labeling - Checklist of items performed attached
to this training record	Employer Training
Officer Jane Doe	Successfully
demonstrated:
100%	9/30/16	

SAFETY TRAINING 
Description, Copy, and Location of Training	Training Provided By	Test / Score (not mandatory) 
	Date Trained	
Attended hands-on backhaul packaging  and safety training in Anchorage	Total Reclaim	See certificate of attendance 	9/17/16	

SECURITY AWARENESS TRAINING 
Description, Copy, and Location of Training	Training Provided By	Test / Score (not mandatory) 
	Date Trained	
Completed PHSMA on-line training hazmat digipak tutorial 7.2. Completed certificate located in file in main office	Employer Training
Officer Jane Doe	Verbal Test
given: Passed	7/17/16	

INDEPTH SECURITY TRAINING 

Description, Copy, and Location of Training	Training Provided By	Test / Score (not mandatory) 
	Date Trained	
Not Applicable