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N95 Training Program Registration Form

You must complete training before you can be fit tested and receive final approval to use a respirator. Proof of training is required before you will be fit tested. Training must be completed annually for use of a respirator.

Once training is completed and your Health Clearance Form and Medical Questionnaire are reviewed, EHS will contact you to schedule a fit test. Please see the schedule of trainings below. You may sign up by filling in the form boxes and clicking "submit".

Training Schedule
Course	Date	Time	Location	Bldg	Room
N95 Training	Tuesday 5/14/2013	9:00-10:00 a.m.	Anschutz Campus	Building 401	Room R09-200
N95 Training	Tuesday 6/11/2013	9:00-10:00 a.m.	Anschutz Campus	Building 401	Room R09-200
N95 Training	Tuesday 7/9/2013	9:00-10:00 a.m.	Anschutz Campus	Building 401	Room R09-200
N95 Training	Tuesday 8/13/2013	9:00-10:00 a.m.	Anschutz Campus	Building 401	Room R09-200

Note: UCD employee ID number needs to be provided at the training session.

Location for all sessions is Anschutz Campus, Building 401 Room R09-200

Employee or Student ID Number:*
Last Name*
First Name*
Email*
Job Title
Department or Class Name:*
Campus Phone Number:
Campus Mailbox:*
PI/Supervisor/Instructor Name:*
PI/Supervisor/Instructor Mailbox:*
Examination Date and Time*

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