notification of lead training course...dhhs-0368e authority: p.a. 368 of 1978, as amended page 1 of...
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![Page 1: Notification of Lead Training Course...DHHS-0368E Authority: P.A. 368 of 1978, as amended Page 1 of 1 Notification of Lead Training Course Training Provider No.: Today’s Date: Room](https://reader034.vdocument.in/reader034/viewer/2022042317/5f05c2ee7e708231d414935f/html5/thumbnails/1.jpg)
DHHS-0368E Authority: P.A. 368 of 1978, as amended
Page 1 of 1
Notification of Lead Training Course
Training Provider No.: Today’s Date:
Room Number:
State: Zip:
Start Date End Date
Training Provider:
Training Provider:
Course Address:
City:
Course Information:
Initial Course
Worker
Supervisor
Inspector
Risk Assessor
Start Date End Date Refresher Course
Worker
Supervisor
Inspector
Risk Assessor
Instructor Information:
Name of Principle Instructor(s):
Name of Guest Instructor(s):
Topics Guest Instructor(s) will cover:
This form must be submitted at least seven (7) calendar days prior to conducting the course(s) listed above. If course(s) described above is canceled, or the dates are modified, MDHHS-Healthy Homes Section must be notified no later than 24 hours prior to the original start date.
1/2019 MDHHS-Healthy Homes Section Fax: 517-284-9956 | Phone: 517-335-9390
Class Updates:
Class Canceled Date of cancellation:
Class Moved New class location:
Class Rescheduled New class dates: