University of Minnesota

MERTKA Minnesota Employee Right-to-Know Standard (MN-OSHA Rules Chapter 5206)



Employee Name:____________________________________________________________________

Job Title:___________________________________________________ Class Number___________

Department Name:__________________________________________________________________

Department Address:________________________________________________________________

Name of Trainer:____________________________________________________________________

Qualifications of Trainer:______________________________________________________________




Information: Date of Training
Informed of the intent of the MERTKA standard and FM implementation plan  
Reviewed the location of the chemical inventory and MSDS sheets for FM Division  
Assure the meaning of Permissible Exposure Limits (PELs) is understood  
Reviewed the signs and symptoms associated with exposures to the chemicals used or encountered on job  
Reviewed location and use of personal protective equipment to protect body from chem. exposures  
Reviewed location and use of emergency response equipment  
Viewed FM online Hazard Communication Training Program  
Viewed FM online Heat Stress Training Program  
Viewed FM online Bloodborne Pathogens Training Program  
Viewed FM online Hearing Safety Training Program  
Reviewed physical and health hazards of specific chemicals in the workplace  
Reviewed measures employees can take to protect from exposure to chemicals in the workplace  
Reviewed details of labeling and storage procedures and specific Standard Operating Procedures  
Other topics:  
Effects of UV radiation from sunlight or welding  


The training record provided above is correct as of this date.
Employee Signature__________________________________________ Date___________
(Sign name above)
Supervisor Signature__________________________________________ Date___________
(Sign name above)

Send copy to: Facilites Management Office 241 DAdB