Operator Certification Renewal

Operator's Name *

First

Last

Email *

Phone Number

Company Name

Do you possess an unrestricted and current driver’s license? *

Would you able to produce a negative drug/alcohol screen test within last 60 days? *

In the last 2 years, do you have less than 2 lost-time Injury accidents? *

If you answered 'No' to any of the above question(s) you must provide a written explanation of why the Operator no longer meets this requirement.

File Upload- Headshot Image OR email image to info@csda.org. This is for your updated ID Card.

Click or drag a file to this area to upload.

Headshot image should be from the shoulders up with the operator against a neutral background. Remove hats, sunglasses and any face coverings.

To the best of my knowledge as the Certified Operator or as the authorized person on behalf of the Certified Operator, I certify all information is true and accurate. *

First

Last

Signature *

Date *

Operator Certification Renewal

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