Safe Kids | Program Management Tool

SENIOR CHECKER REGISTRATION

1 Login Information
2 Senior Checker Profile

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Provide login details

First Name *

Last Name *

Email *

Password *

Confirm Password *

ORGANIZATION INFORMATION

Organization

Street *

City *

State *

Phone *

Fax

Coalition *

CERTIFICATION INFORMATION

Certification ID *

Certification Date *

Certification Expiration Date *

CPS EXPERIENCE

Number of Inspection Stations attended (SKBU/non SKBU) *

Number of SKBU Inspection Station Attended *

Number of CSS personally checked *

Frequency of participation in checkup events *

Total years of experience in the CPS field *

Number of Events attended (SKBU/non SKBU) *

Number of SKBU Event attended *

Do you have extensive knowledge and use of the SKBU Child Passenger Checklist form? *

Yes

Please describe any additional inspection/education experience in the past 12 months including inspection stations, one-on-one consultation, CSS distribution programs, etc. *

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