Jenkins Academy of Applied Technology

Responder training and competency record

HAZWOPER — Emergency Response Requirements · v1.0.0 · October 22, 2026

Course developed by Todd Jerome Jenkins, MS, CSP.

Complete this worksheet using the actual workplace and current plan. A blank form or course score is not evidence that the action occurred. Record actual dates and observations. Print or save a completed copy before closing; entries are not automatically stored. Keep private health details out of this worksheet.

Person, employer, assigned role and authorized tasksExact regulatory role: awareness, operations, technician, specialist or commander; advisory/skilled-support basis if applicableQualified trainer/evaluator, actual training dates, hours or permitted experience basisAll applicable competencies, safe evaluation methods and observed results; attach task-specific evidenceEmployer certification where required, limitations and remediation before assignmentAnnual refresher content/duration or competency statement and retained methodologyMedical/respiratory readiness confirmation without diagnoses; actual employer authorization