Title Page
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Name of Operator / Organisation
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Name and Title of Dangerous Goods Coordinator :
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Telephone Number
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E-mail
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Site conducted
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Conducted on
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Prepared by
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Location
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Address of Facility
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Telephone
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Name and Title of Contact Person
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Telephone
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E-mail
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Type of Operation
TRAINING PROGRAM
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Title of Training Program :
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Address Of Facilities :
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Category of Personnel to Whom The Training Was Provided :
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Number of person Attending
INSTRUCTOR
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Name and Title of Instructor :
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Telephone :
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Fax :
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E-mail
COMMENTS ON COURSE CONTENT
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Comments
COMMENTS ON THE TEST / EXAMINATION
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Comments
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Does the course meet the objective and syllabus or curricular
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Can the training program be approved :
INSPECTOR
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Name and Title of Inspector:
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Signature
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Date
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Telephone
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Fax
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Email
OBSERVATION
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Observation
