HSI Certification CE Report Form

Members holding a current HSI Handbook and/or HSI Fabrication certification can remain certified by completing 10 hours of job-related continuing education (CE). Verification that CE has been completed during the three-year term of certification is required.
Please complete and submit this form no later than 30 days after your certification expiration date.

Please provide the following information:

First Name:
Last Name:
Company Name:
Email:

Certification:

Please check all those that apply:
Composite Hose Handbook Certified
Corrugated Metal Hose Handbook Certified
Fluoropolymer Hose Handbook Certified
Hydraulic Hose Handbook Certified
Industrial Hose Handbook Certified
Composite Hose Fabrication Certified
Corrugated Metal Hose Fabrication Certified
Fluoropolymer Hose Fabrication Certified
Hydraulic Hose Fabrication Certified
Industrial Hose Fabrication Certified
What type of job-related training did you participate in? Check all those that apply:
HSI Regional Training (10 hrs)
NAHAD Annual Meeting (5 hrs)
New Employee/Mentor Training (5 hrs)
University of Innovative Distribution (5 hrs)
Hose & Coupling World (4 hrs)
Manufacturer Training
Sponsor: Hours:
Safety Training
Sponsor: Hours:
Skills Training (Ex. Crimper Training, Welding or Rigging Certification)
Sponsor: Hours:
Other
Please Describe: Hours:
Other
Please Describe: Hours:

Required Notice:

I attest that during my current certification period I participated in a minimum of 10 hours of job-related training as indicated above.
   - denotes required fields

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