DEPARTMENT OF LABOR & INDUSTRY BUREAU OF OCCUPATIONAL & INDUSTRIAL SAFETY LEAD TRAINEE EVALUATION FORM002 (Must be submitted within 5 days of completion of training002 and must be submitted with the Lead Trainee Sign-in Sheet(s). 002Can be mailed, faxed to 717-705-0196, or emailed to CALBOIS@pa.gov.)002 Trainee Information Trainee must complete this section. Please print neatly in ink, using your legal name. City State Zip Code City State Zip Code Training Provider Information Instructor must complete this section. Please print neatly in ink. Worker Inspector City State Zip Code Auxiliary aids and services are available upon request to individuals with disabilities.002 Equal Opportunity Employer/Program002 LIBI-606L REV 10-18 (Page 1 of 1)