Refinery Safety Technician Certificate

Refinery Safety Technician Certificate Refinery Safety Technician Certificate
Application Form

Requirements for R.S.T. Certificate of Completion

  • To earn the certificate participants must complete a total of nine (9) required courses; at least five (5) courses must be completed through the CSUDH OTIEC.
  • All courses must be completed within five (5) years. The official certificate start date is determined by the first day of the first courses the participant wishes to count toward the certificate.
  • 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.

Student Information


[Name as it should appear on the printed Certificate]

[Include Street Address, City, State and Zip Code]

Required Courses (check all that apply)

Prerequisite (1 Course)

— OR —

Required (6 Courses)






Electives (Complete 2):









Student Signature