Institute for Safety and Health Management

ASHM Application Form

The application will need to be completed in one session. If you close the application before completing it, no information will be saved and the application will have to be started over again. Once the application is completed print it for your records and then click on the envelope on the left side of the PDF toolbar to email it to ISHM. Please attach a copy of your driver’s license as a PDF file before sending. Typing your name and date on the signature line constitutes an electronic signature. Applications not completely filled out will not be considered. Applications not completely filled out will not be considered.

Transcripts, if required, should be original copies mailed to :

Institute for Safety and Health Management
4841 East County 14 Ľ Street
Yuma, AZ 85365

Note: If application fee is paid by check or money order please mail to the address above.

After you have been designated an ASHM you may sit for the CSHM exam with two years of safety experience. The ASHM designation will be dropped if you do not sit for the CSHM exam within six years.

Revised 7-23-2009

ASHM Application Form

CSHM Application Form:

The application will need to be completed in one session. If you close the application before completing it, no information will be saved and the application will have to be started over again. Once the application is completed print it for your records and then click on the envelope on the left side of the PDF toolbar to email it to ISHM. Please attach a copy of your drivers license as a PDF file before sending. Typing your name and date on the signature line constitutes an electronic signature.

Your references can also electronically fill in the forms applicable to them and email in the same manner.

Transcripts must be original copies mailed to:

Institute for Safety and Health Management
4841 East County 14 Ľ Street
Yuma, AZ 85365

Note: If application fee is paid by check or money order please mail to the address above.

Once your CSHM application has been approved, you will be eligible to sit for the CSHM exam. The CSHM exam must be completed within one year of approval date. Exam procedures and requirements are listed on the website. You must notify the Institute and pay the examination fee at least 30 days prior to sitting for the exam.

Revised 7-23-2009

CSHM Application Form

Reference for CSHM Application Form

CSHM Suspended Application Form

ASHM to CSHM Application Form:

The application must be filled out online in one session, downloaded, and sent via e-mail to ISHM. Prior to applying for CSHM certification, you must complete two years of Professional Safety Work Experience.

ASHM to CSHM Application Form

Your references can also electronically fill in the forms applicable to them and email in the same manner. Transcripts must be original copies mailed to:

Institute for Safety and Health Management
4841 East County 14 Ľ Street
Yuma, AZ 85365

Forms are in Adobe Acrobat (pdf) format. To ensure you are able to view and print forms, make sure you have the latest version of Adobe Acrobat Reader. Download Adobe Acrobat Reader

Back to the CSHM Information Home Page

For further information, contact Larry Curtis, the Managing Director, of the Institute at (1-877-201-4053)