OSHA 10-Hour
General Industry
& Forklift Safety /
/ Hosted at
929 Joe Frank Harris Pkwy Cartersville, GA 30120
January 27, 28 & 29
Deadline to Register:
2 pm, January 13 /
What you will learn:
· Introduction to OSHA
· Walking and Working Surfaces / Fall Protection
· Exit Routes/ Emergency Action Plans /Fire Prevention
· Electrical Safety
· Machine Guarding
· Personal Protective Equipment
· Hazardous Communications
· Machine Guarding
· Introduction to Industrial Hygiene
· Lock Out / Tag Out
· Bloodborne Pathogens
· Ergonomics
· Material Handling/Lifting
· Forklift Safety
TO QUALIFY
· Complete a Registration Form
· Provide a Picture ID & an original Social Security Card
· Attend MUST’s Back to Work class (Cartersville Goodwill Career Center; January 6 or 13; begins a 10 am, ends at 2 pm)
· Complete a brief interest inventory
The Alliance will work together to achieve:
Group and individualized learning designed so participants increase their knowledge of workplace safety and decreasing workplace liability.
Provide safety training that may not have been present in the past, leading to employment that may not have been available prior to participation in this program.
Our PPE Partner:
61% of the people trained in this program have found gainful employment.
Benefits to You
· Recognized industry certification for those who score 70% or higher
· Potential for higher starting salary with certification and experience
· Career growth
- FREE safety shoes for all who pass the certification.
What participants are saying
“I learned more about health and safety in a few days than most people will learn in a lifetime.”
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“I have a job and use the materials from the class every day.”
What employers are saying
“If I were looking for a supervisor, I would look for one with safety training.”
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“If I had to choose between someone who had OSHA training and someone who did not, I would choose the one with the training.”
OSHA General Industry & Forklift Safety Registration Form
Name Date of Birth
LAST FIRST MIDDLE INITIAL
Social Security Number Gender: Male / Female
Ethnicity: Hispanic Non-Hispanic
African American/Black / American Indian/Alaskan / AsianCaucasian/White / Pacific Islander / Other
Street Address Apartment No.
City State Zip
Best Phone Email
Highest Education Completed:
Work History: Longest period of employment: Type of Work:
Military Service
Branch Air Force Army Marines Navy Coast Guard Grade Discharge Status
Household Income Sources (circle): Employment / Child Support / TANF / Workers Comp / Disability/SSI / Unemployment
Monthly Amount: $ End Date:
Health concerns that may affect your ability to work
m Substance Abuse m Physical Disability m Other:
m Mental Illness m Illiterate or Marginally Literate
m HIV/AIDS and Related Diseases m Domestic Violence
m Developmental Disability m Chronic Health Condition
How will you get to training and work?
Own a car/truck / Public Transportation / Ride from a friend / Walk/ride bikeHave you ever been convicted of a felony or misdemeanor? Yes No
Charge Dates Incarcerated Probation Date Completed
F / M / Y / NF / M / Y / N
Acknowledgement and Agreement
By signing, I am asking the MUST Ministries staff to assist me with an employment search, training, or referral to additional services. The information I have provided is complete, true, and accurate. I understand that if I have not been honest, it will adversely affect my job search and my ability to receive assistance from MUST Ministries.
Affidavit Verifying Status of Benefit Application:
By executing this affidavit, I understand that any person who knowingly or willfully makes a false, fictitious or fraudulent statement of representation in an affidavit shall be guilty of a violation of Code Section 16-10-20 of the Official Code of Georgia.
_____ I am a US citizen or legal permanent resident 18 years of age or older.
_____ I am a qualified alien or non-immigrant under the Federal Immigration and Naturalization Act 18 years of age or older and lawfully present in the US.
Signed Date
You will be notified if selected to participate
AGENCY USE: Location: BTW c ID c Interest c c c c c c