IASHEP Voluntary Surrender Form

Per the International Association of Safety, Health & Environmental Professionals (IASHEP)
policy, an IASHEP professional credential holder agrees to voluntarily surrender their
certification under the following terms.
The Diplomate:
1. Must submit this form prior to expiration of their IASHEP certification. Failure to
submit this form prior to voluntary surrendering their IASHEP professional credential will
cause the IASHEP professional credential holder to be listed as “DECERTIFIED”.
2. Cannot be engaged in an unresolved IASHEP ethics case.
3. Relinquishes their International Association of Safety, Health & Environmental
Professionals (IASHEP) certification but is not restricted from practicing in their
occupational field.
4. Can no longer use the IASHEP certification designation except when also referencing
the years of certification, e.g., Certified Safety, Health & environmental Professional
(CSHET), 2014-2019.
5. Can no longer use the IASHEP embossing seal or stamp for any professional activity.
6. Is relieved of certification maintenance requirements and fees for the Voluntary
Surrender Professional Credential.
7. Will be listed on the IASHEP website as a Former Professional Credential Holder
8. For reactivation rules, see the IASHEP website under forms.
9. Will be subject to IASHEP ethics case provisions if found to be in violation of this
agreement’s terms. No unresolved ethics issues and paid up on fees.
IASHEP Professional Credential being voluntary surrendered i.e. (CEHSP)
__________________________________________________________________
Reason for Voluntary Surrendering IASHEP professional credential i.e Obtained higher
level IASHEP professional credential, Retiring, not working in that field etc.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Name: ______________________________________________________________
Mailing Address:
City _____________________________________________
State: _________________________________________________________
Zip Code:_______________________________________________________
______________________________________________________________
Phone Number: __________________________________________________
Email Address: __________________________________________________
Voluntary surrender takes effect after IASHEP acknowledgment of the Voluntary
Surrender form. I have reviewed and accept the policy and terms as stated above:
Signature: ________________________________________________
Date:____________________________________________________