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Name
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Contact Information
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Address
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Street Address
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Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Employment Information
Currently employed
Yes
No
Current Employer
Employer Address
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Position
Years in present position
Preferred mailing address
Work
Home
Do you work in the field of OHS?
Yes
No
Please state affiliated fields
Healthcare
Quality Assurance/Management
HR
Legal
Other
Demographic Information
Current Professional Designations
Associate Safety Professional (ASP)
Canadian Registered Safety Professional (CRSP)
Canadian Risk Management (CRM)
Certified Industrial Hygienist (CIH)
Certified Occupational Health Nurse (COHN)
Certified Professional Ergonomist (CPE)
National Construction Safety Officer (NCSO)
Health and Safety Administrator (HSA)
Registered Occupational Hygienist (ROH)
Canadian Registered Safety Technician (CRST)
Certified Health and Safety Consultant (CHSC)
Certified Health and Safety Management System Auditor (CHMSA)
Certified Safety Professional (CSP)
IOSH Chartered Fellow (CFIOSH)
IOSH Chartered Member (CMIOSH)
Chartered Professionals in Human Resources (CPRH)
Other not listed
Industry Experience
Agriculture/Forestry/Food
Chemical/Allied Products
Communications
Computer/Electrical
Construction
Consulting
Government/Public Sector
Healthcare
Insurance/Risk Management Services
Manufacturing
Mining
Non-profit/Membership Organizations
Oil/Gas/Petrochemical
Services – Retail
Services – Travel/Recreation
Services – Other
Transportation
Utilities
Wholesale Trade
Other not listed
Areas of Expertise/Interest
Audits
Education/Training
Emergency Planning
Ergonomics/Human Factors
Facilities and Equipment Design
Fire Prevention/Protection
Generalist/Comprehensive
Hazard Analysis
Healthcare
Industrial Hygiene/Biological Monitoring
Inspections
International
Laboratory Safety
Law and Ethics
Management Systems and Programs
Material Handling
Medical Service/First Aid/CPR
Occupational Health
Product Safety
Public Safety
Regulatory/Legislation
Risk Management
Speaker/Seminar Leader
Transportation
Workplace Wellness
Others not listed
Hidden
Highest Level of Education
High School
Certificate/Diploma Program
Technical Institute
University Degree
Masters
PhD
College/University Name
Certificate/Degree Awarded
OHS Experience
Years of experience
Reason for Joining (select all that apply)
Networking
Professional Development
Mentoring Program
Other
Membership in Other Associations
Alberta Occupational Health Nurses' Association (AOHNA)
Alberta Occupational Safety Auditor's Association (AOSAA)
Alberta Society of Health and Safety Professionals (ASHSP)
America Industrial Hygiene Association (AIHA)
American Society of Safety Engineers (ASSE)
Auditing Association of Canada (AAC)
Canadian Society of Safety Engineering (CSSE)
Other(s)
Volunteer Interests
Optional (select all that interest you)
Communications Committee
Events Committee
Grants & Sponsorship Committee
Mentorship Committee
Membership Committee
Strategic Partners Committee
Would you like to be a mentor?
Yes
No
Would you like to be a mentee?
Yes
No
If you were referred by a current WOHSS member, please type their name here:
I authorize verification of the accuracy of the information provided on this form.
If accepted, I agree to be governed by the By-laws, Code of Ethics and Code of Conduct of WOHSS, as they are now or may hereafter become.
I consent to WOHSS using my personal information provided in this application for purposes described in the WOHSS
Privacy Policy
.
I accept
*
I accept
Membership Type
*
Associate
General
Student
Total
Credit Card
Card Details
Cardholder Name
"
*
" indicates required fields
1
Membership Information
2
Membership Payment
Personal Information
Email
*
Name
*
First
Last
Identified Gender
Male
Female
Prefer Not to Answer
Contact Information
Phone
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Employment Information
Currently employed
Yes
No
Current Employer
Employer Address
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Position
Years in present position
Preferred mailing address
Work
Home
Do you work in the field of OHS?
Yes
No
Please state affiliated fields
Healthcare
Quality Assurance/Management
HR
Legal
Other
Demographic Information
Current Professional Designations
Associate Safety Professional (ASP)
Canadian Registered Safety Professional (CRSP)
Canadian Risk Management (CRM)
Certified Industrial Hygienist (CIH)
Certified Occupational Health Nurse (COHN)
Certified Professional Ergonomist (CPE)
National Construction Safety Officer (NCSO)
Health and Safety Administrator (HSA)
Registered Occupational Hygienist (ROH)
Canadian Registered Safety Technician (CRST)
Certified Health and Safety Consultant (CHSC)
Certified Health and Safety Management System Auditor (CHMSA)
Certified Safety Professional (CSP)
IOSH Chartered Fellow (CFIOSH)
IOSH Chartered Member (CMIOSH)
Chartered Professionals in Human Resources (CPRH)
Other not listed
Industry Experience
Agriculture/Forestry/Food
Chemical/Allied Products
Communications
Computer/Electrical
Construction
Consulting
Government/Public Sector
Healthcare
Insurance/Risk Management Services
Manufacturing
Mining
Non-profit/Membership Organizations
Oil/Gas/Petrochemical
Services – Retail
Services – Travel/Recreation
Services – Other
Transportation
Utilities
Wholesale Trade
Other not listed
Areas of Expertise/Interest
Audits
Education/Training
Emergency Planning
Ergonomics/Human Factors
Facilities and Equipment Design
Fire Prevention/Protection
Generalist/Comprehensive
Hazard Analysis
Healthcare
Industrial Hygiene/Biological Monitoring
Inspections
International
Laboratory Safety
Law and Ethics
Management Systems and Programs
Material Handling
Medical Service/First Aid/CPR
Occupational Health
Product Safety
Public Safety
Regulatory/Legislation
Risk Management
Speaker/Seminar Leader
Transportation
Workplace Wellness
Others not listed
Hidden
Highest Level of Education
High School
Certificate/Diploma Program
Technical Institute
University Degree
Masters
PhD
College/University Name
Certificate/Degree Awarded
OHS Experience
Years of experience
Reason for Joining (select all that apply)
Networking
Professional Development
Mentoring Program
Other
Membership in Other Associations
Alberta Occupational Health Nurses' Association (AOHNA)
Alberta Occupational Safety Auditor's Association (AOSAA)
Alberta Society of Health and Safety Professionals (ASHSP)
America Industrial Hygiene Association (AIHA)
American Society of Safety Engineers (ASSE)
Auditing Association of Canada (AAC)
Canadian Society of Safety Engineering (CSSE)
Other(s)
Volunteer Interests
Optional (select all that interest you)
Communications Committee
Events Committee
Grants & Sponsorship Committee
Mentorship Committee
Membership Committee
Strategic Partners Committee
Would you like to be a mentor?
Yes
No
Would you like to be a mentee?
Yes
No
If you were referred by a current WOHSS member, please type their name here:
I authorize verification of the accuracy of the information provided on this form.
If accepted, I agree to be governed by the By-laws, Code of Ethics and Code of Conduct of WOHSS, as they are now or may hereafter become.
I consent to WOHSS using my personal information provided in this application for purposes described in the WOHSS
Privacy Policy
.
I accept
*
I accept
Membership Type
*
Associate
General
Student
Total
Credit Card
Card Details
Cardholder Name
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