Healthcare Safety Technician Certificate Request

HST - Healthcare Safety Technician Certificate Healthcare Safety Technician Certificate
Application Form

Requirements for Certificate of Completion

  • To earn the Healthcare Safety Technician Certificate, the individual will have to successfully complete seven required courses.
  • At least five of the courses, including the final two, must be completed through the CSUDH OTIEC.
  • All courses must be completed within a 5 year period. The official “certificate enrollment date” is the first day of the first CSUDH OTIEC course the participant wishes to count towards the certificate of completion.

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]

Certificate Courses (check all that apply)

Required (7 Courses)

The following courses have been approved through curriculum process.

Student Signature