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MIT Registration Form For PCO Training

This document is a registration form for a basic and refresher training course for Pollution Control Officers (PCOs). It collects information such as the participant's name, contact details, educational background, employer information, the nature of their plant/business operations, and how their operations are categorized in terms of chemical usage, waste generation, emissions and discharges. It also provides the training fee details, which is PHP 7,000 inclusive of meals and materials, and accepts payment via cash, check or bank deposit.
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0% found this document useful (0 votes)
133 views1 page

MIT Registration Form For PCO Training

This document is a registration form for a basic and refresher training course for Pollution Control Officers (PCOs). It collects information such as the participant's name, contact details, educational background, employer information, the nature of their plant/business operations, and how their operations are categorized in terms of chemical usage, waste generation, emissions and discharges. It also provides the training fee details, which is PHP 7,000 inclusive of meals and materials, and accepts payment via cash, check or bank deposit.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BASIC AND REFRESHER TRAINING COURSE FOR

POLLUTION CONTROL OFFICERS (PCOs) REGISTRATION FORM


PARTICIPANT INFORMATION Please fill out completely for logistic purposes

NAME___________________________________________________________________________________NICKNAME_____________________________
PRINT (LAST) (FIRST) (M.I.)

SEX_____________ CIVIL STATUS____________________ DATE OF BIRTH_________________________

NAME OF OFFICE/COMPANY_____________________________________________________________________POSITION__________________________
OFFICE/COMPANY ADDRESS___________________________________________________________ __________PHONE NO._________________________
FAX_________________________________ EMAIL______________________________________________ ___CELLPHONE _______________________

EDUCATIONAL ATTAINMENT: (Name of School, Degree Attained, Year Graduated)


College_________________________________________________________________________________________________________________________

NATURE OF PLANT/BUSINESS OPERATIONS


 Automotives (manufacturing / assembly / distribution / services)  Metal (steel manufacturing, etc.) / Ship Building Construction &
 Canning Infrastructure (including contractors)
 Chemical / Pharmaceuticals / Cosmetics  Mining / Cement / Ceramics / Tiles / Glass
 Consultancy / Services (TSDs) / Laboratories (non-medical labs)  Paper / Printing / Textile {manufacturing of garments) / Tannery /
Education / NCOs Rubbery / Plastics (moulding) / Wood
 Electrical (manufacturing / assembly / distribution of cables, transformers, etc.)  Petrochemicals / Petroleum / Refineries (depots / gas stations)
 Electronics / Semi-Conductor (manufacturing / assembly / distribution)  Power Generation & Distribution (power plants / grids, etc.)
 Food & Beverages (manufacturing)  Real Estates (subdivisions, residential buildings or condominium,
 Hospital and Health care institutions (including clinics, funeral memorial parks) / Recreational Facilities (hotel, resorts)
parlors, columbaria, crematorium, diagnostic labs, etc.)  Sugar / Distillery / Ethanol (manufacturing)
 IT Facilities & Services (telecom, cell sites, etc.)  Vegetable Oil (Oil Mills, manufacture of cooking oil) / Detergent Wax
 LGUs (departments/PGENRO,MENRO, City ENRO, Local WD, etc.)  Warehousing and Logistics (including port operations)
 Livestock / Poultry / Feeds / Agriculture  Others, specify:

CATEGORIZATION:
 Chemical Usage, Storage and/or Handling:
Using, storing, and/or handling chemicals which are not listed in PCL: ___YES ___NO
 Hazardous Waste Generated: ___Small generator ___Large generator
 Air Emissions: ___Stack sampling required ___Stack sampling not required
 Solid Waste Generated: ___Generates less than 30kg/day ___Generates more than 30kg/day
 Wastewater Discharged: ___Discharges less than 30m3/day ___Discharges more than 30m3/day
 Sludge Generated: ___None ___Contracts a TSD

TRAINING FEE (inclusive of meals, training kit, training module, e-copy of presentation materials and training certificate)
Live-Out @ Php 7,000.00
Meal Inclusion: Three (3) Lunch meals and Six (6) AM/PM Snacks
MODE OF PAYMENT
 Cash
 Cheque: Payment will be done during the training
Please prepare check payable to MIT Center for Sustainable Resource Management
 Deposit through Bank:
Account Name : MIT Center for Sustainable Resource Management
Account No. : 010998000631
Name of Bank : Banco de Oro (BDO)
Branch : Davao - Calinan

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