SAFETY TRAINING RECORD

Company: [COMPANY NAME]
Training Program: [PROGRAM NAME]
Training Date: [DATE]
Trainer: [TRAINER NAME & QUALIFICATIONS]
Training Location: [LOCATION]

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SECTION 1: TRAINING PROGRAM DETAILS

Course Title: [COURSE TITLE]
Course Code: [COURSE CODE]
Duration: [HOURS/DAYS]
Training Method: □ Classroom □ Online □ Hands-on □ Field Training
Certification Valid Until: [DATE]
Renewal Required: □ Yes □ No
Renewal Period: [FREQUENCY]
Regulatory Requirement: □ OSHA □ Local □ Company □ Industry

SECTION 2: LEARNING OBJECTIVES

Upon completion of this training, participants will be able to:
• [OBJECTIVE 1]
• [OBJECTIVE 2]
• [OBJECTIVE 3]
• [OBJECTIVE 4]
• [OBJECTIVE 5]

SECTION 3: TRAINING CONTENT COVERED

Module 1: [MODULE NAME]
Topics Covered:
• [TOPIC]
• [TOPIC]
• [TOPIC]
Duration: [TIME]
Method: □ Lecture □ Discussion □ Demonstration □ Practice

Module 2: [MODULE NAME]
Topics Covered:
• [TOPIC]
• [TOPIC]
• [TOPIC]
Duration: [TIME]
Method: □ Lecture □ Discussion □ Demonstration □ Practice

Module 3: [MODULE NAME]
Topics Covered:
• [TOPIC]
• [TOPIC]
• [TOPIC]
Duration: [TIME]
Method: □ Lecture □ Discussion □ Demonstration □ Practice

SECTION 4: PRACTICAL EXERCISES

Exercise 1: [DESCRIPTION]
Competency Demonstrated: □ Yes □ No
Score: [SCORE/TOTAL]
Comments: [COMMENTS]

Exercise 2: [DESCRIPTION]
Competency Demonstrated: □ Yes □ No
Score: [SCORE/TOTAL]
Comments: [COMMENTS]

Exercise 3: [DESCRIPTION]
Competency Demonstrated: □ Yes □ No
Score: [SCORE/TOTAL]
Comments: [COMMENTS]

SECTION 5: ASSESSMENT RESULTS

Written Test:
Score: [SCORE] / [TOTAL] ([PERCENTAGE]%)
Passing Score: [MINIMUM PERCENTAGE]%
Result: □ Pass □ Fail
Date: [DATE]

Practical Assessment:
Result: □ Pass □ Fail
Score: [SCORE/TOTAL]
Comments: [COMMENTS]
Date: [DATE]

Overall Result: □ Competent □ Not Yet Competent
Remedial Training Required: □ Yes □ No
If yes, areas needing improvement: [AREAS]

SECTION 6: PARTICIPANT INFORMATION

Name: [FULL NAME]
Employee ID: [ID NUMBER]
Department: [DEPARTMENT]
Position: [JOB TITLE]
Supervisor: [SUPERVISOR NAME]
Date of Hire: [DATE]
Previous Safety Training: [LIST PREVIOUS TRAINING]

Contact Information:
Email: [EMAIL ADDRESS]
Phone: [PHONE NUMBER]
Emergency Contact: [NAME & PHONE]

SECTION 7: ATTENDANCE RECORD

Day 1: [DATE] | Hours: [HOURS] | Signature: ________________
Day 2: [DATE] | Hours: [HOURS] | Signature: ________________
Day 3: [DATE] | Hours: [HOURS] | Signature: ________________
Day 4: [DATE] | Hours: [HOURS] | Signature: ________________

Total Training Hours: [TOTAL HOURS]
Attendance Rate: [PERCENTAGE]%

SECTION 8: COMPETENCY CHECKLIST

The participant has demonstrated competency in:

Core Safety Competencies:
□ Hazard identification and risk assessment
□ Use of personal protective equipment
□ Emergency procedures and evacuation
□ Incident reporting procedures
□ Safe work practices for assigned tasks
□ Equipment operation and maintenance
□ Chemical handling and storage (if applicable)
□ First aid and emergency response
□ Regulatory compliance requirements
□ Company safety policies and procedures

Job-Specific Competencies:
□ [SPECIFIC COMPETENCY]
□ [SPECIFIC COMPETENCY]
□ [SPECIFIC COMPETENCY]
□ [SPECIFIC COMPETENCY]
□ [SPECIFIC COMPETENCY]

SECTION 9: TRAINER EVALUATION

Participant Performance:
Understanding of Material: □ Excellent □ Good □ Satisfactory □ Needs Improvement
Participation Level: □ Excellent □ Good □ Satisfactory □ Needs Improvement
Practical Skills: □ Excellent □ Good □ Satisfactory □ Needs Improvement
Safety Awareness: □ Excellent □ Good □ Satisfactory □ Needs Improvement

Strengths Demonstrated:
• [STRENGTH]
• [STRENGTH]
• [STRENGTH]

Areas for Improvement:
• [AREA]
• [AREA]
• [AREA]

Additional Comments:
[TRAINER COMMENTS]

SECTION 10: FOLLOW-UP REQUIREMENTS

Immediate Actions Required:
• [ACTION] - Due Date: [DATE]
• [ACTION] - Due Date: [DATE]

Refresher Training Scheduled:
Date: [DATE]
Topics: [TOPICS]
Frequency: [ANNUAL/BIANNUAL/AS NEEDED]

On-the-Job Monitoring:
Supervisor: [NAME]
Monitoring Period: [DURATION]
Review Date: [DATE]
Monitoring Checklist: □ Attached □ To be developed

SECTION 11: CERTIFICATION

This is to certify that [PARTICIPANT NAME] has successfully 
completed the [TRAINING PROGRAM NAME] and has demonstrated 
competency in all required areas.

Certificate Number: [CERTIFICATE NUMBER]
Issue Date: [DATE]
Valid Until: [EXPIRY DATE]
Issuing Authority: [ORGANIZATION]

Trainer Signature: _________________ Date: _______
[TRAINER NAME & QUALIFICATIONS]

Supervisor Signature: ______________ Date: _______
[SUPERVISOR NAME]

Training Manager: _________________ Date: _______
[TRAINING MANAGER NAME]

SECTION 12: TRAINING EFFECTIVENESS EVALUATION
(To be completed 30-90 days after training)

Has the participant applied the training in their work?
□ Yes □ No □ Partially
Comments: [COMMENTS]

Are safety practices being followed consistently?
□ Yes □ No □ Sometimes
Comments: [COMMENTS]

Any incidents or near-misses since training?
□ Yes □ No
If yes, describe: [DESCRIPTION]

Has workplace safety improved since training?
□ Significantly □ Somewhat □ No change □ Declined
Comments: [COMMENTS]

Additional training needed?
□ Yes □ No
If yes, specify: [TRAINING NEEDED]

Evaluated by: [NAME] Date: [DATE]
Position: [TITLE]

SECTION 13: RECORD KEEPING

Original Record Location: [LOCATION]
Copy Provided to Employee: □ Yes □ No
Copy to Personnel File: □ Yes □ No
Copy to Training Database: □ Yes □ No
Copy to Supervisor: □ Yes □ No
Retention Period: [YEARS]

SECTION 14: REGULATORY COMPLIANCE

Training meets requirements of:
□ OSHA Standards (specify): [STANDARD]
□ Local Regulations (specify): [REGULATION]
□ Company Policy (specify): [POLICY]
□ Industry Standards (specify): [STANDARD]
□ Client Requirements (specify): [REQUIREMENT]
□ Other: [SPECIFY]

SECTION 15: TRAINING PROVIDER INFORMATION

Organization: [TRAINING PROVIDER]
Accreditation: [ACCREDITATION DETAILS]
Trainer Qualifications: [QUALIFICATIONS]
Contact Information: [CONTACT DETAILS]
Training Materials Used: [MATERIALS LIST]

SECTION 16: PARTICIPANT FEEDBACK

Training Quality: □ Excellent □ Good □ Satisfactory □ Poor
Trainer Effectiveness: □ Excellent □ Good □ Satisfactory □ Poor
Materials Quality: □ Excellent □ Good □ Satisfactory □ Poor
Relevance to Job: □ Excellent □ Good □ Satisfactory □ Poor
Facility/Equipment: □ Excellent □ Good □ Satisfactory □ Poor

What did you like most about the training?
[FEEDBACK]

What could be improved?
[FEEDBACK]

Would you recommend this training to others?
□ Yes □ No
Why? [EXPLANATION]

Additional Comments and Suggestions:
[PARTICIPANT FEEDBACK]

Participant Signature: _____________ Date: _______

SECTION 17: DOCUMENT CONTROL

Form Version: 3.0
Form ID: TR-001
Last Updated: [DATE]
Next Review: [DATE]
Approved by: [NAME & TITLE]

DISTRIBUTION:
□ Participant
□ Supervisor
□ Training Department
□ Human Resources
□ Safety Department
□ Personnel File
□ Regulatory File (if required)

CONFIDENTIALITY NOTICE:
This training record contains confidential employee information 
and should be handled according to company privacy policies.