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LEVEL ONE & LEVEL TWO CERTIFICATES Progress Log / Application Form
MIOSHA Training Institute certificates will be awarded upon successful completion of the required + elective courses listed for each program. There is no expiration or renewal for these programs. The intent of this form is for you to track the courses you complete and then submit this same form as application. Please retain a copy of this application for your own records. All MTI classes statewide will be transcripted at MacombCC, and you may view your progress online with WebAdvisor: https://webadvisor.macomb.edu/.
WebAdvisor most effective for transcripts if you provide full SocSec# on MTI registration forms, or birthdate may be alternate unique identifier for your records.
MTI_1617_ProgressLogApp / Rev.07-15-2016
Level One – Safety & Health General Industry Certificate Timeline to complete Level One is 3 years from date of first course attended in this track.
2 COURSES REQUIRED:
Date-s Attended Location Attended
MIOSHA General Industry 10-Hour + (3-day course)
Elements of a Safety & Health Management System (2-day) (formerly titled Blueprint S&H Mgmt System)
SELECT 2 ELECTIVE COURSES FOR TOTAL 4 COURSES:
*Asterisk notates course eligible toward multiple MTI certificate programs.
* Supervisor’s Role in Safety & Health
* When MIOSHA Enforcement Visits
Machine Guarding & Hazard Identification
* Human Factors Engineering (formerly titled Ergonomic Principles)
Job Safety Analysis, Made Easy (Effective March’2014, eligible elective for L1GI Certificate) Fact (this course also meets requirements for Level Two Health Certificate)(or if you successfully completed MIOSHA Recordkeeping & Cost of Injuries before 10/2016, still eligible elective for L1GI Certificate)
Level One - Safety & Health Construction Certificate Timeline to complete Level One is 3 years from date of first course attended in this track.
3 REQUIRED COURSES:
Date-s Attended Location Attended
MIOSHA Construction 10-Hour Course
MIOSHA Construction – Part 45 Fall Protection (Required effective 4/26/13, previously elective)
Health Hazards in Construction (Required effective 7/9/12, previously elective)
SELECT 4 ELECTIVE COURSES, TOTAL 7 COURSES:Asterisks notate course meets requirements also for other *Level One or **Level Two Certificate tracks.
** MIOSHA Recordkeeping & Cost of Injuries
* Supervisor’s Role in Safety & Health
* When MIOSHA Enforcement Visits
Asbestos & Lead Awareness
Electricity: The Invisible Killer
Excavations: The Grave Danger
Part 2 (CS) – Masonry Wall Bracing
Part 10 (CS) – Cranes and Derricks
Part 12 (GI) – Scaffolds & Scaffold Platforms
Part 13 (CS) – Mobile Equipment & Work Zone Safety
Part 32 (CS) – Aerial Work Platforms
**Part 451 (OH) – Respiratory Protection
**Parts 6 (CS), 33 & 433 (GI) – Personal Protective Equipment Standards for GI & CS
**Parts 17 (CS), 39 & 40 (GI) – Electrical Standards for General Industry & Construction
**Parts 92 & 430 (GI), 42 (CS) – Hazard Communication & Right to Know Requirements
(GI) = General Industry Safety Standards, (CS) = Construction Safety Standards, (OH) = Occupational Health Standards.
Occupational Health CertificateAsterisks notate course eligible also toward other *Level One or **Level Two Certificate.
TOTAL 5 COURSES REQUIRED:
Date-s Attended Location Attended
**Parts 92 & 430 (GI), 42 (CS) – Hazard Communication & Right to Know Requirements
**Part 380 (OH) –Occupational Noise Exposure & Hearing Conservation
**Part 451 (OH) – Respiratory Protection
**Part 472 (OH)– Medical Services, First Aid & Part 554 (OH)–Blood Borne Infectious Diseases
*Human Factors Engineering (formerly titled Ergonomic Principles)
Or
**Parts 90 (GI) & 490 (OH) – Permit Required Confined Spaces
Level Two - Safety & Health Management Systems Certificate TOTAL 6 COURSES REQUIRED: (Note- Job Safety Analysis class eligible only if attended prior to March’2014)
Date-s Attended Location Attended
Advanced Accident Investigation
Behavior-Based Safety: Fundamentals & Implementation (New Mar’2014, previously required JSA)
Continuous Safety & Health Improvement
Creating a Positive Safety Culture
Effective Safety & Health Training
*MIOSHA Recordkeeping & Cost of Injuries (or if completed Workplace Inspection before 10/2016, still eligible)
Level Two – MIOSHA Compliance – General Industry Certificate ** Double-asterisk notates courses meeting requirements also for other Level Two Certificate tracks.
4 COURSES REQUIRED:
Date-s Attended Location Attended
Part 7 (GI) – Guards for Power Transmission
Part 85 (GI) – Control of Hazardous Energy Sources
**Parts 17 (CS), 39 & 40 (GI) – Electrical Standards for General Industry & Construction
**Parts 92 & 430 (GI), 42 (CS) – Hazard Communication & Right to Know Requirements
SELECT 5 ELECTIVE COURSES FOR TOTAL 9 COURSES:
Industrial Laser Safety
Industrial Robot Safety
Part 1 (GI) – General Provisions
Parts 2, 3 & 4 (GI)– Floor/Wall Openings, Stairways and Skylights, Ladders
Part 14 (GI) – Conveyors
Part 21 (GI) – Powered Industrial Trucks: What Every Trainer & Operator Should Know
Part 24 (GI) – Mechanical Power Presses
**Parts 6 (CS), 33 & 433 (GI) – Personal Protective Equipment Standards for GI & CS
**Parts 90 (GI) & 490 (OH) – Permit Required Confined Spaces
**Part 380 (OH) –Occupational Noise Exposure & Hearing Conservation
**Part 451 (OH) – Respiratory Protection
**Part 472 & 554 (OH)– Medical Services and First Aid, Bloodborne Infectious Diseases
(GI) = General Industry Safety Standards, (CS) = Construction Safety Standards, (OH) = Occupational Health Standards.
Level Two – MIOSHA Compliance –Construction Certificate
TOTAL 8 COURSES not previously attended for Level One Construction Certificate:
(All Construction courses are listed on previous page, see Level One Construction) Date-s Attended Location Attended
Name (exactly as you would like it printed on your certificate) _________________________________________________
Birthdate or SocSec# ____________________ Phone ____________________ Email ___________________________ Mailing Address preferred to receive your certificate:
Home Employer - Company Name: _________________________________________________________________
Address: __________________________________________________________________________________________________
City, State Zip: ____________________________________________________________________________________________
Applications are processed in the order received. Verified applications will have certificate printing occur on the 10th of each month. Allow 6-8 weeks processing to receive your certificate. Applications are required by postal mail, email or fax: Yvonne Grant/office – 586-498-4106
Macomb Community College Attention: Yvonne Grant / MTI 21901 Dunham, ClintonTownship MI 48036 or email to: [email protected] or fax to: 586-498-4058
www.michigan.gov/mti • www.macomb.edu/mti