Form OHSA Form 182 OHSA Form 182 Student Data Form

https://oshaelearning.geniussis.com/PublicStudentSignUp.aspx

Registration

FORM APPROVED
OMB NO. 1218-0172
Expiration Date: 08-31-2026

New to the Learning Portal? Create your account below.
1. First Legal Name*:

First Legal Name*
2. Middle Legal Name:

Middle Legal Name
3. Last Legal Name*:

Last Legal Name*
4. Select Job Classification*:

Select Job Specialization*
5. Official Work Email*:

Email*
6. Confirm Work Email*:

Confirm Work Email*
7. Work Phone Number*:

Work Phone Number*
8. Cell Phone:

Cell Phone

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https://oshaelearning.geniussis.com/PublicStudentSignUp.aspx

9. Are you a State Plan OSHA or Consultation Employee*?

Yes
10. Are you a Supervisor*?

Yes
11. Select Affiliation (Org Name)*:

Select Affiliation (Org Name)*...
12. Work Street Address 1*:

Work Street Address 1*
13. Work Street Address 2:

Work Street Address 2
14. Work City*:

City*
15. Select Work State*:

Select Work State*
16. Work Zip*:

Work Zip*
17. Supervisor First Legal Name:

Supervisor First Legal Name
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18. Supervisor Last Legal Name*:

Supervisor Last Legal Name*
19. Supervisor Work Phone Number*:

Supervisor Work Phone Number*
20. Supervisor Work Email*:

Supervisor Work Email*
21. Confirm Supervisor Work Email*:

Confirm Supervisor Work Email*

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https://oshaelearning.geniussis.com/PublicStudentSignUp.aspx

22. Password*:

Password*
23. Confirm password*:

Confirm password*

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Public reporting burden for this collection of information is voluntary and is estimated to average 5 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the Office of Training Institute, OSHA Office of Training and Education, 2020 S. Arlington Heights Road,
Arlington Heights, Illinois 60005-4102. Persons are not required to respond to the collection of information unless
it displays a current valid OMB control number.

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Student Data Form Submission Instructions
(New Hire Enrollment)
•
•

Please ensure names and emails are spelled correctly (as they appear in Blackboard).
Enter work phone numbers using the following format: ###-###-####

Enter the following information in items 01 – 21:
Item 01 - First Legal Name
Item 02 - Middle Legal Name
Item 03 - Last Legal Name
Item 04 - Job Classification (see instructions)
Item 05 - Official Work Email Address
Item 06 - Confirm Work Email
Item 07 - Work Phone Number
Item 08 - Cell Phone
Item 09 - Are you a State Plan OSHA or Consultation Employee? Y/N
Item 10 - Are you a Supervisor? Y/N
Item 11 - Select Affiliation (see instructions)
Item 12 - Work Address 1
Item 13 - Work Address 2
Item 14 - Work City
Item 15 - Work State
Item 16 - Work Zip
Item 17 - Supervisor First Legal Name
Item 18 - Supervisor Last Legal Name
Item 19 - Supervisor Work Phone
Item 20 - Supervisor Work Email
Item 21 - Confirm Supervisor Work Email
Special Instructions:
• Item 04: Enter one of the following job classifications (do not enter anything other than one of
these choices):
o
o

Industrial Hygienist
Safety Specialist Construction

o

Safety Specialist General Industry

•

Note: Learning Path is determined by Job Classification for CSHOs and Enforcement (does not
apply to Consultation).

•

Item 11: Affiliation/Office Name
o Federal Office: Enter the Area Office Name (e.g. Toledo)
o State Plan: Enter your Blackboard Affiliation Name (e.g. Arizona Enforcement)
o Consultation: Enter your Blackboard Affiliation Name (e.g. Arizona Consultation)