The individual provider must maintain a signed and dated certificate of completion of safety training, issued by HCQA or any of its training contractors that provides the safety training that includes:

(1) The trainee's name;

(2) Title(s) of the specific information taught;

(3) Signature of the person overseeing classroom-based safety training indicating completion of the required information;

(4) The location or method of the safety training; and

(5) The date(s) of the safety training.