EOHSS Classroom Training Registration Form

Items marked with * are required.

Select a training class*
Campus Maps: Piscataway/New Brunswick/Stratford/Camden/Newark/Scotch Plains

First Name*:
Middle Initial:
Last Name*:

UMDNJ Employee ID number*:
The University ID can be found on each employee's paystub.   Alternatively, the University ID can also be accessed by logging into My UMDNJ.  In the box on the left, entitled UMDNJ Toolbox, click on University Wide Toolbox, and then My University ID.

If you do not have a University ID Number, please indicate your classification, e.g., RWJMS medical/Rutgers/High School student, Volunteer, Per-diem or name of outside employer/agency.

Confirmation of your registration will be sent to your e-mail address.

Email address*:
Repeat email address*:   (validate)
Additional alternate address that training registration confirmation should be sent to:

Department*
Department (other if not listed)
Work Address (Building, Room)*
Work Telephone Number (xxx-xxx-xxxx Ext:xxx)*
Position Title*
Supervisor*(Last name First name)
Lab Personnel: indicate the person the lab is assigned to)
Do you work in a laboratory that handles pathogens, recombinant DNA human or other primate cells or tissues? *
Do you work in a laboratory that handles radioactive materials or X-ray machines? *
Are you a patient care provider? *
Are you an administrative person working in a clinical setting? *
Are you involved with shipping packages containing dry ice, biological or hazardous materials? *
Do you work with any lasers? *

Comments:(additional phone number you can be reached at if the class is cancelled and other comments)


  

If you have any questions, please call EOHSS at 732-235-4058 for Piscataway/New Brunswick or 856-566-6189 for Stratford/Camden or 973-972-4812 for Newark/Scotch Plains or email to eohsshelp@umdnj.edu.