NONDESTRUCTIVE TESTING Wisconsin Department of Transportation

PERSONNEL QUALIFICATION RECORD

DT2112 2004
Employee Name

Project ID

Current Certification Status

Meto!"s#

$ecertification Due Date"s#

$ecertifie! %y Continuin& Satisfactory E'perience
Date

(y

Qualification Examination Results
)eneral*(asic "Insert Meto!#

Date

+!ministere! (y

Specific "Insert Meto!#

Date

+!ministere! (y

Practical "Insert Meto!#

Date

+!ministere! (y

Composite Score

,erifie! (y

Vision Examinations
Near ,ision +cuity "+nnual#
Date

+!ministere! (y

+ccepta%le -naccepta%le
Correcti.e /enses $e0uire!
1es No
Color Contrast "2 1ears#
Date

+!ministere! (y

Tainin!" NDT#Relate$
Course Title Date"s# Duration
"3ours#
Instructor /ocation +ppro.e! 4E'am"s#
)i.en



4If 0ualification e'aminations 5ere a!ministere!6 recor! te applica%le scores in te 7-+/I8IC+TI9N
E:+MIN+TI9N $ES-/TS %loc;6 a%o.e<
Te a%o.e name! employee as satisfactorily met te 0ualification re0uirements of te Wisconsin Department
of Transportation 5ritten practice in accor!ance 5it SNT=TC=1+ "2001#< 9ter !etails of 0ualification6 if any6
are maintaine! on file an! are a.aila%le for au!it upon re0uest<
(y

Date