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OSHA Training Resources > Resource Center Loan Program > Forms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Printing Instructions |
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OSHA Office of Training and Education Resource Center Loan Program 2020 S. Arlington Heights Road Arlington Heights, Illinois 60005 Telephone: (847) 759-7736 Fax to: (847) 759-7748 or (847) 297-4874 |
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Resource Center Borrowing Agreement | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Please type or print clearly in black ink | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
I will abide by the policies set forth in the policy statement. I understand that the copyright law of the United States (Title 17, U.S. Code) governs the reproduction of copyrighted materials. Private institutions, associations, and companies that are covered by this law produced most of the materials which are available for loan. I SHALL NOT duplicate or otherwise reproduce these materials without the expressed written permission of the producer. I understand that it is essential to return materials no later than the Due Date. Materials returned after the due date are considered LATE. Upon my third LATE return my borrowing privileges will be canceled. If I lose or damage the materials, I will be responsible for paying for their replacement. I HAVE READ AND UNDERSTOOD THE ABOVE. I AGREE TO COMPLY WITH THE RULES AND POLICIES OF THE RESOURCE CENTER LOAN SERVICE. Today’s Date: _________________________ Name: _______________________________________________________________________________ Signature: _____________________________________________________________________________ Business Name: _________________________________________________________________________ Address: ______________________________________________________________________________ City:_____________________________________________ State: ________ Zip Code: _____________ Business Phone: (_____)_______________________ Home Phone : (_____)________________________ FAX Number: (_____)______________________ E-mail Address: _________________________________ Borrower Category: ______________________________________________________________________ Indicate borrower category: Federal OSHA, State OSHA, OSHA Consultation, OSHA Outreach Trainer, OSHA Cooperative Program Member including SHARP, VPP, Alliance, and Strategic Partnership, or Other Federal Agency S&H Trainer. |
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OSHA Office of Training and Education Resource Center Loan Program 2020 S. Arlington Heights Road Arlington Heights, Illinois 60005 Telephone: (847) 759-7736 Fax to: (847) 759-7748 or (847) 297-4874 |
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Resource Center Loan Request | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Please type or print clearly in black ink | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Name: ______________________________________________ Today's Date: ______________________ Business Name: _________________________________________________________________________ Business Address (No P.O. Boxes): _________________________________________________________ City: ___________________________________________ State: ________ Zip Code: _______________ Telephone Number: (____)_______________________ Fax Number: (_____)_______________________
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Occupational Safety & Health Administration 200 Constitution Avenue, NW Washington, DC 20210 |
Page last updated: 11/20/2006 |