Note: The reference form should be completely filled out. Those providing the reference should have personal knowledge of the applicants Safety and Health work activities. When finished click on the submit button at the bottom of the page. References may be mailed directly to ISHM or to the applicant for forwarding.
The applicant named below is seeking designation as a Certified Safety and Health Manager (CSHM) by meeting academic and experience requirements, passing an examination, and receiving satisfactory references. Important information as to the applicant’s qualifications will be provided from your evaluation, assisting in making decisions for examination and certification. Your honesty and assistance in this matter is appreciated.
You may mail this form to us at 4841 East County 14 1/4 Street Yuma, AZ 85365. To print this form, right click the form and select Print.
ISHM is environmentally friendly and primarily uses email for day to day business purposes.
During what period do you have personal knowledge of the applicant's professional safety and health management qualification?
I certify the information provided by me regarding the applicant is true and accurate to the best of my knowledge.
