
	Workplace Injury Prevention Week includes: Accidents Don't Just Happen -- Perfecting Your IIPP Incident Investigation & Root Cause Analysis Your Vehicle/Fleet Safety Program Can Save Lives & Money Essentials of Hazardous Materials Management (formerly CHMM Review) Monthly Online Ergo Series - 2 New Series for 2009! FREE 1-, 2- or 3- HOUR WORKSHOP: BUSINESS PLANNING TO SURVIVE PANDEMIC FLU & Other Disasters Don't Forget All of Our OSHA Courses!

Cass Ben-Levi, MA
Program Director
Continuing Education and Outreach
UCLA School of Public Health
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650 Charles E Young Dr. South
56-071 CHS
P.O. Box 951772
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Telephone: 310-206-2304
Email: cbenlevi@ucla.edu

Needs Assessment Form
This questionnaire will assist the Southern California Education and Research Center in planning continuing education programs in the various occupational health and safety disciplines. Your assistance in completing this questionnaire is appreciated and could benefit you and others in these professions. (If your web software does not support interactive forms, please email us at erc@ph.ucla.edu for a printed version of the form.)

*Email Address:

*Name:

Company/Organization:

Title:

*Address:

*City:

*State:

*Zip Code:

*Phone:

Fax:

Your profession? (pick one)

Occupational Medicine	Industrial Hygiene
Occupational Health Nursing	Occupational Safety
Physical/Occupational Therapy	Engineering
Management or Supervision	Labor Representative
Other

Your employer category? (pick one)

Private Industry	Independent Consultant
Organized Labor	Academic Institution
Insurance	Federal Government
State Government	Local Government
Other:

How do you usually learn about continuing education program offerings?
(Check as many as apply.)

Advertisement or announcements in publications

Receiving direct mail program flyers

Local professional society announcement

Word-of-mouth from colleagues

Publicity via email lists, or the World Wide Web

Other (please describe in the comments box below

Would you consider registering for an SC ERC continuing education activity
in one of the following formats: (Check as many as apply.)

Website

CD-ROM

Satelliate television

Please consider the following topic areas and check those in which your
need for continuing education is high:

PROFESSIONAL REVIEW COURSES

Occupational Health Nursing Certification Review

Comprehensive Industrial Hygiene Review

Occupational Physician Certification Review

Certified Safety Professional Review

MANAGEMENT & LEGAL ISSUES

Topic Area	Basic	Advanced
Legal Issues in Occupational Health & Safety
Management/Admin for Occupational Health Profession
Americans with Disabilities Act
Workers' Compensation
Strategic planning & cost containment
Leadership skills for occupation safty & health professionals

INFORMATION TOOLS & COMMUNICATIONS RESOURCES

Topic Area	Basic	Advanced
Computers in Occupational Health & Safety
Internet Applications for Occupational Health & Safety
Workplace Health Promotion
Right-to-know & Hazard Communication
Communications in Accident Prevention
Train the Trainer

GENERAL OCCUPATION PRACTICE

Topic Area	Basic	Advanced
Occupational Epidemiology
Occupational Medicine
Occupational Health Nursing
Occupational Respiratory Disease
Industrial Hygiene
Occupational Safety
Occupational Stress
HAZMAT Training

SPECIFIC WORKPLACE HAZARDS & CONCERNS

Topic Area	Basic	Advanced
Biohazard Science
Toxicology
Lead
Asbestos
Hearing Loss/Conservation Programs
Respiratory Protection
Back Injury Prevention
Environmental Audits
Ergonomics
Exposure Assessment
Injury Prevention
Health Promotion in the Workplace
Confined Space Safety & Compliance
Nonionizing Radiation
Radiation Protection
Workplace Violence
Workplace Reproductive Hazards
Ventilation
Indoor Air Quality
Other Workplace Issues

Comments on needs for specific continuing education programs:

Thank you for helping us offer you better service!

How do you usually learn about continuing education program offerings? (Check as many as apply.)