Working at Heights Training Form
Please complete this form to record details of your working at heights training session.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Training
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Trainer Name
*
Type of Training
*
Initial Certification
Refresher Course
Site-Specific Training
Previous Working at Heights Experience
*
Yes, more than 2 years
Yes, less than 2 years
No prior experience
Equipment Used During Training
*
Full Body Harness
Lanyard
Self-Retracting Lifeline
Anchor Points
Other
Assessment Result
*
Pass
Fail
Requires Follow-up
Certificate Issued
*
Yes
No
Additional Notes
Submit
Should be Empty: