August 6, 2024 – IIPP Course Registration
9:30 AM - 12:30 PM
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First and Last Name *
Email *
Phone number *
Job Title *
Company, Agency, or Organization *
Business City, State, and ZIP Code *
Is the business private or public? *
Which industry best describes your company or organization? *
Are you the designated person responsible for worker health and safety at your workplace? *
If NO, is there such a person?
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Approximately how many people work in your workplace? *
What language(s) do your employees speak? *
Required
Please list any organizations or associations your workplace is affiliated with *
What motivated you to attend this training? *
Do you require any accommodations in order to participate in this course? If so, please elaborate
 *
In order to participate, you will need access to a computer with a working microphone and camera. You should also have Zoom installed as well as a web browser (such as Google Chrome or Mozilla Firefox). Do you have access to these?
 *
Do you consent to us taking your picture for use in LOHP's social media? (You are not obligated to do so and may still participate if you decline)
 *
Have you attended any other workplace health and safety training sessions in the past 5 years? *
How did you hear about this training? *
What are you most hoping to get out of this course? *
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