Title Please Select Miss Ms. Mrs. Mr. Dr. First Name*First Name is Required Last Name*Last Name is Required Address City Province*Province is required Please Select AB BC MB NB NL NS NT NU ON PE QC SK YT =============================== AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Postal Code*Postal Code is Required Email Address* Invalid email Email Address is Required Confirm Email Address* Invalid confirm email Email addresses do not match. Preferred Telephone What is the best time to call you if necessary? Fax Number What is the name of your company or organization?*Company/Organization name is required How many employees? Is your company/organization unionized?

Yes

No

If yes, which Union? Please Select - Other - Air Line Pilots Association-International Alliance Employees Union Alliance of Canadian Cinema, Television & Radio Artists Amalgamated Transit Union Association des enseignantes et des enseigants franco-ontariens Association of Management, Administrative and Professional Crown Employees of Ontario Association of Professional Student Services Personnel Bakery, Confectionery, Tobacco Workers and Grain Millers' International Union Brick and Allied Craft Union British Columbia Teachers' Federation Canadian Actors Equity Association Canadian Association of University Teachers Canadian Labour Congress Canadian Media Guild Canadian Office and Professional Employees Union Canadian Postmasters and Assistants Association Canadian Union of Postal Workers Region Ontario Canadian Union of Public Employees Canadian Union of Skilled Workers Central Ontario Building Trades Communication Workers of America Educational Assistants Association Educational Resource Facilitator of Peel Elementary Teachers` Federation of Ontario Glass, Molders, Pottery, Plastics and Allied Workers International Union International Alliance of Theatrical Stage Employees International Association of Fire Fighters International Association of Machinists International Brotherhood of Boilermakers Canada International Brotherhood of Electrical Workers International Brotherhood of Teamsters International Federation of Professional and Technical Engineers International Longshore and Warehouse Union International Plate Printers, Die Stampers and Engravers' Union of North America International Union of Bricklayers and Allied Craftworkers International Union of Elevator Constructors International Union of Operating Engineers International Union of Painters and Allied Trades Ironworkers Union Labourers International Union of North America Major League Baseball Players Association Millwrights Regional Council of Ontario National Hockey League Players' Association National Union of Public and General Employees Ontario English Catholic Teachers Association Ontario Federation of Labour Ontario Nurses’ Association Ontario Pipe Trades Council Ontario Professional Firefighters Association Ontario Provincial Police Association Ontario Public Service Employees Union Ontario Secondary School Teachers’ Federation Ontario Teachers’ Federation Operative Plasterers' and Cement Masons' International Association Ottawa Newspaper Guild Police Association of Ontario Power Workers’ Union Practical Nurses Federation of Ontario Professional Institute of the Public Service of Canada Provincial Building and Construction Trades Council of Ontario Public Service Alliance of Canada Seafarers International Union of Canada Service Employees International Union Sheet Metal Workers' and Roofers' International Association Shipyard General Workers' Federation of British Columbia Society of United Professionals Toronto Musicians’ Association Toronto Police Association Toronto Professional Firefighters Association UNIFOR United Association United Association of Plumbers and Pipefitters United Auto Workers United Brotherhood of Carpenters and Joiners United Food and Commercial Workers Union United Steelworkers Are you a WHSC-qualified instructor?

Yes

No

Are you a JHSC member or worker rep?

Yes

No

Are you a graduate of WHSC Training?

Yes

No

Work Environment*Work Environment is required Please Select -I don't know 11 - Agriculture, forestry, fishing and hunting 21 - Mining, quarrying, and oil and gas extraction 22 - Utilities 23 - Construction 31-33 - Manufacturing 41 - Wholesale trade 44-45 - Retail trade 48-49 - Transportation and warehousing 51 - Information and cultural industries 52 - Finance and insurance 53 - Real estate and rental and leasing 54 - Professional, scientific and technical services 55 - Management of companies and enterprises 56 - Administrative and support, waste management and remediation services 61 - Educational services 62 - Health care and social assistance 71 - Arts, entertainment and recreation 72 - Accommodation and food services 81 – Other services (except public administration) 91 – Public administration Prefer not to answer Why do you require this information?*Required information Please Select Delivery of WHSC Training JHSC / Worker Rep Functions Legal Compliance Workplace Hazard Other If Other please specify When do you require this information? MM/DD/YYYY Your inquiry or question