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Olsson Certification
- 1. Anne Rossborough #003-5597 Qualification Summary •NDT Level II – UT • Eye Exam
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- 3. Certification of PersonnelQualification Employee Name: Employee ID #: Testing Method: Certification Date: Certification Level: Expiration Date: Continuing Performance Evaluation(approx. mid-point of 5 yr duration) Date: Formal Education Summary (Formal Education attained and claimed for qualification) Education Location Date Technical Training Summary (Documentation exists which verifies that the above individual meets or exceeds the qualification requirements, in accordance with the written practice of this company.) Course Location Date Lab Hours Hours 1.1.2013 80 80 80 80 Work Experience Summary (The following is a summary of the qualifying work experience claimed for this method by the above Individual, and verified by this company.) Employer Position Hire Date Hours Months 6.1.13 1,200 22 9.1.15 500 3 1700 25 Examination General: 91% Specific: 72% Practical: 92% Composite: 85% Recertification Practical: Certification Level: Verified By: Date of Initial Certification: Certified By: Statement: I, the undersigned verify that all information contained on the Certification of Personnel Qualification form of the above individual is true. The examination scores, dates, names and signatures of qualified examiners listed on these forms were taken from the original or copies of the original documents. 1.7.16 Date 1.7.16 Date SGS NDT Level II NDT Level II UT Thickness Ridgewater College Ridgewater College Willmar, Minnesota 5.17.13 Ultrasonics Lake of the Woods High School Baudette, MN 1986 Anne Rossborough Ultrasonic Testing Level II CF Temp.003 1.7.16 1.31.21 Totals: 11627 Virginia Plaza, Suite 103, LaVista, NE 68128 Printed Name TitleSignature - Company Representative Signature - Authorized NDT Level III Total: II 1.7.16 Michael J. Sullivan Michael J. Sullivan Group Leader - NDT Michael J. Sullivan LMT
- 4. VISION EXAMINATIONS Anne RossboroughAMR-5597 xxx-xx-5597 Applicant’s Name Certification No. Social Security No. 1. Near-Vision Meets without eye correction Meets with eye correction Does not meet Jaeger Number 2 or equivalent at a distance of not less than 12 inches 2. Color Perception Meets without Eye correction Meets with eye correction Does not meet Red/green differentiation Blue/yellow differentiation I, certify that I, ____Michael J. Sullivan_______________, administered an eye exam Printed Name of Eye Examiner to ___Anne Rossborough_______, on______1.7.16 which demonstrated Printed Name of Applicant Mo. Day Year the vision capabilities indicated above. * Required upon initial certification and annually thereafter. ______________________________________ Signature of Eye Examiner x