The BCRSP roster is updated annually for distribution to all CRSPs. Our objective in publishing this roster is to improve the availability of information on CRSPs with competence in science, engineering, management, and the application of safety techniques. Your cooperation in completing and returning this form ensures the accuracy of information in the roster. The bolded fields are mandatory fields.

Name:
Registration #:
Title:
Employer:

Preferred Mailing Address:

 Business Residence

Address:
City:
Province/State:
Postal Code:
Country:
Business Telephone:
Business Facsimile:
E-Mail Address:
Website:

STANDARD INDUSTRIAL CLASSIFICATION (check one only)

Agriculture	Forest Products	Petroleum
Chemicals	Government	Retail
Communications	Health Care	Transportation
Construction	Insurance	Utilities
Consulting	Manufacturing	Other
Education	Mining

AREAS OF SPECIALIZATION (please limit areas to three only - if more than three areas are checked off, only the first three will be listed)

Check only three areas in which you are professionally competent to offer advice to both safety and non-safety personnel on both an internal (your organization) and external basis.

Adminstration	Fault Tree Analysis	Off-job Safety
Adult Learning	Fire Safety	Personal Protective Equipment
Audiology	First Aid	Pressure Vessels
Audits	Fleet Safety	Product Safety
Codes and Standards	Hospital Safety	Radiation
Compensation	Hygiene	Research
Confined Spaces	Inspections	Risk Management
Cost Benefit Analysis	Investigations	Safety Manuals
Court Testimony	Lab Safety	Sawmills
Design	Logging	Security
Electrical Safety	Machine Guarding	Supervisory Training
Emergency Preparedness	Marine Safety	Systems Safety
Environmental Practices	Materials Handling	Toxicity
Ergonomics	Noise	Ventilation and Exhaust
Explosives	Office Safety	Welding and Cutting