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 indicate which certifications you have based on the list below:
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 Hands-On 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, Safety, Skills Training (Eligible: product specific training, workplace safety training, ‎crimper training, welding or rigging certification.)‎
Sponsor	Date	? Hours
Sponsor	Date	? Hours
Sponsor	Date	? 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.