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 Safety Orientation Reservation Form

Name of Plant/Refinery:
Contractors' Safety Council
Of Brazosport, Inc.
1400 Velasco Blvd.
Freeport, Texas 77541
Phone #: (979)233-1818
Fax #: (979)239-4384
 		Your Company Name:
Your Company Address
City,State, Zip Code:
Company Phone #:
Company Fax #:
Your Company Contact Person:


***DATE TO ATTEND ORIENTATION:


Choose one of the following classes:

Site Specific (Must have had Basic Plus within last 12 Months)
Site Specific & Basic Plus
Site Specific & Refresher (Must have had Basic Plus within the last 15 months)
Basic Plus Only
Refresher


LAST NAME
FIRST NAME
SS NUMBER
LOCATION OF BASIC PLUS
CONFIRMED
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2.)



3.)



4.)



5.)





1. Form must be faxed in to CSC office by 3:30 PM prior to training date, no late form will be accepted.
2. By Return Fax you will recieve confirmed registration for your company's trainees.
3. By registering a participant it is understood that there will be a charge for no-shows, and Failures.
4. All Participants must bring State of Government issued Photo ID with them to class.
5. All Participants must bring Basic Plus Card from other Safety Councils with them to class.