Worker Registration Form - norcat.org

1 Completed forms can be emailed to the respective training location, listed above, at least 2 days prior to the chosen session date or faxed to 705-670-2193 (fax for Sudbury location only). Reservations are subject to you attached any additional external documentation (MLTSD records, WHMIS or Fit Tests)? Yes NoNORCAT No. (if available): _____ Birth date (MM/DD/YYYY): _____ Worker 's email:_____ Last Name: _____ First Name: _____ Home Phone #:_____ Trade: _____ Company Name:_____ Company Contact:_____ Company Phone #: _____ Company Email:_____ SUDBURY 1545 Maley Drive Sudbury, ON P3A 4R7 GTA 151 Superior Blvd. Unit 8-10 Mississauga, ON L5T 2L1 TIMMINS 76 McIntyre Road Schumacher, ON P0N 1G0 THUNDER BAY 399 Mooney Avenue Thunder Bay, ON P7B 5L5 DateTheory Date:(MM/DD/YYYY): _____ Practical (if required):(MM/DD/YYYY): _____ Method of Payment Cheque* Debit Cash PO_____ * Personal cheques not accepted Amex MasterCard VISACard Holder:_____Card #: _____ Expiry Date: _____ IMPORTANT!

2 Please note the following: Please bring proof of WHMIS (dated within 1 year) at the time of training as it is a prerequisite for most sites. Program U770010 or U770225 (Common Core) and the General Orientation Pass are prerequisites for the Underground Orientation Pass. Please be prepared to show proof of the Common Core (MLTSD Transcript) prior to training. Validation testing is done between 8am and 3pm, Monday to Friday. Be sure to attach any required external documentation such as MLTSD records, WHMIS or Fit Tests with your completed Registration form. Personal email addresses are only collected for the purpose of sending training does not send confirmation emails. If you do not hear back from us, you have been properly registered. Feel free to contact us to verify TRAINING FOR THE FUTURET raining Requested (check all that apply) Requesting Username and Password Accessibility for Ontarians with Disabilities (AODA) CCSIC Training Program CGS EHS Rules Contractor as Constructor CGS EHS Rules Service Contracts or CGS is Constructor Confined Space Awareness Confined Space Entry (Ontario) De Beers Orientation Eye Fit Testing Fall Protection Awareness High Pressure Washing (theory) High Pressure Washing (practical)* Industrial Vacuum Equipment (theory) Industrial Vacuum Equipment (practical)

3 * Kirkland Lake Gold Detour Lake Mine Process Plant Safety Orientation Kirkland Lake Gold Detour Lake Mine Drive Kirkland Lake Gold Detour Lake Mine Site Orientation Kirkland Lake Gold - Surface Induction Kirkland Lake Gold - Surface/Underground Induction KLPC Site Procedures: Contractor Package Lake Shore Gold Delivery/Driver Orientation Lake Shore Gold Surface/Underground Orientation Lake Shore Gold Surface Induction Lock Out / Tag Out Awareness McEwen Mine General Induction McEwen Mine Mill Induction McEwen Mine Pit & Underground Induction McEwen Mine Surface Induction (Driver Delivery) McEwen WHMIS Update and Annual Refresher Occupational Health and Safety for Supervisors Occupational Health and Safety for Workers Respirator Fit Test - mask (MUST be clean shaven) Respirator Fit Test - Full face (MUST be clean shaven) Respiratory Protection Awareness Service Type Common Core #770225** Sudbury INO General Orientation Sudbury INO Truck Driver Indoc.

4 Sudbury INO TDG - for Shippers Transportation of Dangerous Goods - for Drivers Transportation of Dangerous Goods - for Shippers U0012 - Lock Out & Tag Out + Practical** Wood C t Gold Project Site Orientation Working at Heights (8:00am start) ** Working at Heights Refresher (8:00am start)** WHMIS Other: _____ Training must be completed in-house at NORCAT. Proof of WHMIS and OHS for Workers/Supervisors are also mandatory training before arriving at site. Fit Testings are available between 8:30am and 3pm. Valid McEwen Mine General Induction training is also a prerequisite prior to site arrival. *Theory is completed at NORCAT, practical is completed at BM Metals. **Theory is completed on Mondays & Wednesdays Practical is completed on Tuesdays & Thursdays.

5 ** There is a non-attendance fee of $ + HST. Cancellations must be made at least 24 hours ahead of scheduled Registration FormPlease select your training location:NORC