OSHA Resource Center Loan Program
OSHA Directorate of Training and Education
Resource Center Loan Program
2020 S. Arlington Heights Road
Arlington Heights, Illinois 60005
Telephone: (847) 759-7736

Submit this form via email attachment at least 2 weeks in advance of preferred Date of Use.

First Name: _______________________________ MI: _______ Last Name: _____________________________

Business Name: _______________________________________ Web Address: __________________________

Address: _________________________________________________________ Suite: ____________________

City: ___________________________________________ State: ________ Zip Code+4: __________________

Primary Phone: (____)_________________________ Alternate Phone: (_____)__________________________

Email: ______________________________________________________________________________________
In the last column, please indicate desired action for requested material that may be currently on loan. (R) Reserve or (S) Substitute
RC Use Number Title Date of Use R/S
(C) = Confirmed Booking   (R) = Reserved   (S) = Substitute Material   (N/A) = No Longer Available

Date Shipped: ______________________ Date Due: ______________________

Loan requests must be submitted two weeks in advance from preferred Date of Use.

Submit by email