Advance Safety and Health Certificate

ASH - Advanced Safety & Health Certificate Advanced Safety & Health Certificate
Application Form

Requirements for Certificate of Completion

  • To receive the CSUDH Advanced Safety & Health Certificate participants must complete at least three (3) courses through the CSUDH OTI Education Center.
  • The two final Advanced Safety & Health Certificate courses must be taken through the CSUDH OTI Education Center.
  • All coursework must be completed within three years after the official “certificate enrollment date.” The official “certificate enrollment date” is the first day of the first CSUDH OTI Education Center Certificate class the participant wishes to count towards the Certificate.

Requirements for Courses from Other OTIECs

  • Courses taken through other official OSHA Training Institute Education Centers can be used to fulfill up to four (4) courses required for the certificate of completion if these courses were completed within two (2) years prior to the participant’s official certificate begin date at CSUDH OTIEC.
  • Proof (certificate/transcript) for any course taken at another center should be emailed to titled "Certificate Request {student name}" when submitting a Certificate Request.


Student Information

[Name as it should appear on the printed Certificate]

[Include Street Address, City, State and Zip Code]
Construction Track
General Industry Track

Required Courses (check all that apply)

Construction Track — (4 Required Courses)

— OR —

General Industry Track — (4 Required Courses)

Electives for all Tracks — (3 Elective Courses)

Student Signature