NASP Certification Board CSD Application Form

You must complete the application below and agree to the Code of Ethics and Non-Disclosure Agreement found here to complete your application.

Applications must be completed and submitted within one year from the creation date, or data will be lost and deleted. Once submitted, applications will be reviewed by the NASPCB.

The NASPCB will notify you with one of the following results:

Approved Eligibility
Additional Information Required
Denied Eligibility

If an applicant is notified additional information is required or needs review from an applicant, the application must be updated for completion within one (1) year from the notification date, or the application will expire.

If a candidate does not purchase an exam option within one (1) year of their approval of eligibility date, the exam purchase option will expire. Candidates will have an option within the last 60 days of eligibility to purchase a 90-day eligibility extension.

Please Note: Certificants who hold the CSD or MSP certification and let it expire must wait one (1) year from the expiration date to reapply.

All fees are non-transferable, non-refundable, and subject to change.

Payments must be paid using a VISA, Mastercard, Discover, or American Express credit card.

During the application process, you must select your option for taking the exam through the Certification Board’s testing contractor, Scantron, via live online proctoring (LOP) or at a Scantron test site. After completing the application and being approved to take the exam, candidates will receive official notification from the NASP Certification Board via email within 7-10 business days. After you purchase the exam, you will receive an email notification from Scantron within 2-3 business days with additional instructions. Click here to find information on registering, scheduling, finding a location, and preparing for your exam.

Name (as it appears on your government issued Identification)(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Will you be taking your exam at a Scantron testing center or via online proctoring?

Option 1: LOP (Live Online Proctoring)

Option 2: Scantron Test Site

Special Requirements (Per Americans with Disabilities Act). If you have special requirements for taking your test, please choose from the list below. You will be required to upload a copy of a physician’s letter stating your need for accommodations.

Highest Level of Education(Required)

What Discipline(Required)

Candidates must meet the minimum educational requirement as indicated on the CSD Eligibility Track. Click here for the CSD Eligibility Track. You will be required to upload a copy of an official diploma, transcript or academic record(s) showing degree/s earned and date granted.

Current Credentials

You must hold one of the following credentials as indicated on the CSD Eligibility Track to apply. Please select the credential(s) that you currently hold and enter the certification or certificate number(s). Click here for the CSD Eligibility Track. Additional Information can be found in the NASP/IASP, Inc. Certification Program CANDIDATE HANDBOOK at www.naspweb.com. You will be required to upload a copy of your current credentials.

Certifications/Certificates

Certified Safety Manager (CSM)

Certified Safety Manager (CSM) Certification/Certificate Number(Required)

Certified Safety Director (CSD)

Certified Safety Director (CSD) Certification/Certificate Number(Required)

Licensed Safety Professional (LSP)

Licensed Safety Professional (LSP) Certification/Certificate Number(Required)

Safety Director Certificate (SDC)

Safety Director Certificate (SDC) Certification/Certificate Number(Required)

Safety Professional Certificate (SPC)

Safety Professional Certificate (SPC) Certification/Certificate Number(Required)

Associate Safety Professional (ASP)

Associate Safety Professional (ASP) Certification/Certificate Number(Required)

NEBOSH National or International Diploma in Occupational Health and Safety

NEBOSH National or International Diploma in Occupational Health and Safety Certification/Certificate Number(Required)

Construction Health and Safety Technician (CHST)

Construction Health and Safety Technician (CHST) Certification/Certificate Number(Required)

Occupational Health and Safety Technician (OHST)

Occupational Health and Safety Technician (OHST) Certification/Certificate Number(Required)

Safety Trained Supervisor (STS)

Safety Trained Supervisor (STS) Certification/Certificate Number(Required)

Certified Safety and Health Manager (CSHM)

Certified Safety and Health Manager (CSHM) Certification/Certificate Number(Required)

Certified Safety Professional (CSP)

Certified Safety Professional (CSP) Certification/Certificate Number(Required)

Canadian Registered Safety Professional (CRSP)

Canadian Registered Safety Professional (CRSP) Certification/Certificate Number(Required)

Safety Management Specialist (SMS)

Safety Management Specialist (SMS) Certification/Certificate Number(Required)

State-Sponsored/Recognized EHS Certificate Program

State-Sponsored/Recognized EHS Certificate Program Certification/Certificate Number(Required)

Job Title(Required)

Years of Experience

Candidates must meet the minimum professional safety experience as indicated on the CSD Track. You do not need to submit supporting documents unless you are selected for audit upon completing this application. Click here for the CSD Eligibility Track. Additional Information can be found in the NASP/IASP, Inc. Certification Program CANDIDATE HANDBOOK at www.naspweb.com.

Current Employer

Employer(Required)

Employer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor Name(Required)

Supervisor Email(Required)

Start

Percent of Job in Workplace Safety(Required)

Number of Employees in Facility(Required)

How Many Facilities(Required)

Company Industry(Required)

Primary Safety Specialty(Required)

Previous Employer (if current job does not meet the minimum professional safety experience as indicated on the CSD Track)

Employer

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor Name

Supervisor Email

Start

Percent of Job in Workplace Safety

Number of Employees in Facility

How Many Facilities

Company Industry

Primary Safety Specialty

Previous Employer (if current job does not meet the minimum professional safety experience as indicated on the CSD Track)

Employer

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor Name

Supervisor Email

Start

Percent of Job in Workplace Safety

Number of Employees in Facility

How Many Facilities

Company Industry

Primary Safety Specialty

The NASP/IASP, Inc. Certification Board (NASPCB) has the right to evaluate the character of applicants, candidates, and Certificants of the NASP/IASP, Inc. Certification Program. The NASPCB considers criminal conviction history and known unethical behaviors of each applicant, candidate, and Certificant of the NASP/IASP, Inc. Certification Program.

The following answers are required if they have not been previously released to the NASPCB.

1. Have you ever been convicted of a felony?(Required)

Yes

If Yes, please list(Required)

2. Have you been convicted of a misdemeanor within the last five (5) years?(Required)

Yes

If Yes, please list(Required)

3. Do you have a record of any unethical behavior?(Required)

Yes

If Yes, please list(Required)

4. Have you ever had a professional registration, license, or certification denied, suspended, or revoked other than for lack of minimum qualifications, failure of examination, or failure to pay renewal fees?(Required)

Yes

If Yes, please list(Required)

Signature(Required)

Please type your name to indicate that you agree to the Code of Ethics and Non-Disclosure Agreement found at the bottom of this page.

NASP/IASP, Inc. Certification Program/NASPCB’s CSD & MSP Directory of Credentials (should you successfully become a certificant of the CSD Credential):

Personal information, including certificant name, city, state, country, current NASPCB credential(s) held, credential number(s), and photo (if uploaded to the NASP Learning Management System), will be available to all persons seeking information from the NASP/IASP, Inc. Certification Board/NASPCB’s public CSD & MSP Directory of Credentials. This directory is designed for potential employers to verify credentials of job candidates.(Required)

I consent to my name and certification information being accessible to persons seeking information from the NASP/IASP, Inc. Certification Program/NASPCB’s public CSD & MSP Directory of Credentials.

I do NOT consent to my name and certification information being accessible to persons seeking information from the NASP/IASP, Inc. Certification Program/NASPCB’s public CSD & MSP Directory of Credentials.

NASP/IASP, Inc. Certification Program/NASPCB’s CSD & MSP Directory of Credentials Contact Information:

This option will allow persons seeking to contact a certificant to confidentially send a message to the certificant through the Contact feature in the Certificant’s profile. Interested parties will not be able to view the Certificant’s email address or any personal information unless the certificant chooses to communicate with the interested party.(Required)

I consent to having my contact information included in the NASP/IASP, Inc. Certification Program/NASPCB’s public CSD & MSP Directory of Credentials.

I do NOT consent to having my contact information included in the NASP/IASP, Inc. Certification Program/NASPCB’s public CSD & MSP Directory of Credentials.

File

Max. file size: 8 MB.

Appendix J

NASP/IASP, Inc. Certification Program

NASP/IASP, Inc. Certificant’s Code of Ethics and Professional Standards Agreement

The NASP/IASP, Inc. Certification Board (NASPCB) Code of Ethics and Professional Standards is to be observed by all holders of NASPCB certifications. Holders of NASPCB certifications shall endeavor to maintain and advance the integrity and honor of the profession of workplace safety and, in so doing, shall adhere to these standards.

Pursue, above all else, the preservation of life and prevention of injury to those for whom we are responsible in the workplace.
To honestly and fully represent to the employer the requirements and best practices of protection of the employee.
To be fair, honest, and impartial in all work activities.
To adhere to the highest standards of ethical behavior in our work.
To accept responsibility for continuing self-improvement through continuing education and development and remaining current on developments in the field of workplace safety.
To define our own knowledge/skills/abilities honestly and accurately to those we serve.
To maintain objectivity in all professional judgments refusing to bend to interests to compromise the safety of those we serve.
To act in a manner free of bias regarding religion, ethnicity, gender, age, national origin, sexual orientation, or disability.
To maintain the high honor of the NASPCB certificants by quickly, honestly, and completely reporting to NASPCB any NASPCB certificant who violates these principles.

I understand that violations of the Code of Ethics and Professional Standards could result in the suspension or complete withdrawal of my certification. Should the case arise, I agree to refrain from further promotion of my certification and references to my certification status in perpetuity or until an appeal for the cause of the suspension/withdrawal has been conducted and satisfied.

NASP/IASP, Inc. Candidate’s Examination Non-Disclosure and Confidentiality Agreement

I agree that as a candidate for the NASP/IASP, Inc. Certification Program NASPCB certifications, I am required to keep secure and not disclose the contents of the examination and examination items. I understand that revealing the contents of the examination, either by orally repeating the contents of any question or information to anyone (including an instructor or educator) or by writing down any of the questions or information, is considered a violation of this Non- Disclosure and Confidentiality Agreement to which I am hereby agreeing. If I violate the Examination Non-Disclosure and Confidentiality Agreement, my examination will be voided, and any certification awarded to me will be withdrawn.

NASP/IASP, Inc. Criminal Conviction and Unethical Behavior Agreement

The NASP/IASP, Inc. Certification Board (NASPCB) has the right to evaluate the character of applicants, candidates, and Certificants of the NASP/IASP, Inc Certification Program. The NASPCB considers criminal conviction history and known unethical behaviors of each applicant, candidate, and Certificant of the NASP/IASP, Inc Certification Program. It is required at the time of submitting an application that this information is provided. I agree that the information provided is truthful and accurate at the time of the completion of the application. I understand that providing false, inaccurate, or inadequate detail and supporting documents may result in the denial of my application and potential disciplinary action by the NASP/IASP, Inc. Certification Board (NASPCB).

Confirmation(Required)

By checking this box, you are attesting that you have received, read, fully understand and consent to the Certificant’s Code of Ethics and Professional Standards Agreement, Candidate’s Non-Disclosure and Confidentiality Agreement, and Criminal Conviction and Unethical Behavior Agreement as set forth by the NASP/IASP, Inc. Certification Board.

Phone

This field is for validation purposes and should be left unchanged.