NASP Certification Board Master Safety Professional

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

First

Middle

Last

Company *

Address 1 *

Address 2

City *

State *

Province

Postal Code *

Country *

Email *

Phone *

Program *

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). Please provide a physician’s letter stating your need for accommodations. (Does NOT apply to Live Online Proctoring)

If you have special requirements for taking your test please chose from the list above.

Job Title *

Years of Experience *

Current Certifications *

Please list all certifications you currently hold separated by commas. If you do not hold any certifications enter "None."

Highest Level of Education *

What Discipline *

Percent of Job in Workplace Safety

Number of Employees in Facility

How Many Facilities

Company Industry

Primary Safety Specialty

Signature *

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.

File Upload

Click or drag files to this area to upload. You can upload up to 10 files.

Please upload any necessary documents here. Files cannot exceed 2MB in size.