Training Request Questionnaire

*Please identify the organization or website you received this survey from.

*Name:

*Company Name:

*Address 1:

Address 2:

*City:

*State:

*Zip:

*Phone:

*Your Email:

What type of training session are you requesting?
For a private company location.A Supplier/vendor or other public event

*Please specify the course(s) you are interested in.

*What type of course would you prefer?
Company program specific customized courseGeneral regulatory awarenessQualified person level materialsTrain the Trainer level course

*Have your employees been trained in the last three years on electrical safety?

YesNo

*Do you have an electrical and/or arc flash safety policy?

YesNo

*Which edition of NFPA 70E was your policy based on?

2024202120182015Prior to 2015I dont knowDont have a Policy

*Please select all of the items you would like to have included in your course. Press and Hold CTRL button for multiple selections

Hands-on training/evaluation componentCourse examination testCertificate of completionAbility to reinforce sections as neededAbility to have recording of training sessions for reuse or refresher

* Please check any of these items your employees use for PPE. Press and Hold CTRL button for multiple selections

Arc rated clothing optionsVoltage rated gloves and leather protectorsArc rated hoodHard hat and Blast shieldArc rated balaclava

* Based on the your choices above (knowing that the more comprehensive the course is, the more time that will be needed); which best represents the length of the course you prefer?

1-2 hours4 hours8 hoursMulti-dayI would like the consultant to recommend what is needed.

*How many sessions will be needed to get everyone trained?

Is there a deadline training needs complete by? (if so please list)

Do you have specific days of the week training would need to be scheduled on? (if so please list)

*Do you plan on having students of various electrical knowledge in the same session?

YesNo

*Can this course be scheduled during normal business hours? (Mon-Fri, 1st Shift)?

YesNo

*How many employees do you estimate will need to be trained? (Please specify)

Have you had an arc flash analysis done on your electrical system?

YesNo

Will you have engineering staff in class?

YesNo

Will you have management/ program decision makers in class?

YesNo

Would you prefer a separate class to cover program / policy requirements/ provisions or include all in main class?

SeparateIncluded in main class