Trainee Name____________________________

Trainee Social Security Number: ____________

Trainee Status:  _______

Course Name: ___________________

Course Code: ___________________                                 

National Center Course Number: ___________

Date Course Completed: ____________________

Performance Criteria Completed:  _____________

Performance Objectives:

                                                                                                                    Pass     Fail                  

Topic 1: Electrical Safety

1.1  Describe what current, voltage, and resistance are.

1.2  Describe factors that affect the severity of an electrical
shock.

1.3  Describe the physical effects of current passing through
the human body.

1.4  Identify and describe hazards associated with working near
electrical equipment.

1.5  Describe ways of providing protection to personnel from
hazards associated with electricity.

1.6  Describe how to safely give aid to an electrical shock victim.

1.7 Describe how to safely respond to an electrical fire.

Performance Evaluator’s Signature _______________________________

Performance Evaluator’s Name (Print) ____________________________

Date Completed: _____________________________________________