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SASH Registration Form with UCLA LOSH
(May 26 and 28)

The School Action for Safety and Health (SASH) course will teach you how to identify and solve common health and safety problems in your workplace. You will also learn to identify work- related accidents, injuries, and illnesses, and how to involve employees in your safety program. Participants will receive a free printable guidebook and easy-to-use Injury and Illness Prevention Program (IIPP) template as well as factsheets and tools to help you implement your IIPP.
1.First and Last Name?(Required.)
2.Personal Email Address?(Required.)
3.Job Title(Required.)
4.Is your employer a:(Required.)
5.Which district do you work in?(Required.)
6.Which county do you work in?(Required.)
7.If you work for a school or school district, what department do you work in?(Required.)
8.What language(s) do you speak at home (comment all that apply)?(Required.)
9.Are you responsible for writing your district's COVID-19 Protection plan?(Required.)
10.Are you a member of a union?
11.If Yes, which union?
12.If yes, do you have a leadership role?
13.Is there a health and safety committee that includes a focus on employee health and safety at your employer?(Required.)
14.Are you responsible for carrying out health and safety activities in your district?(Required.)
15.Are you responsible for writing your district's Injury and Illness Prevention Plan?(Required.)
Current Progress,
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