+-----------------------------------------------------------------------+
| +---------------+--------------------------------+---------------+    |
| | LS-           | **NSLS New Employee/Guest      | 01/11/2008    |    |
| | TRN-ORF-0001\ | Orientation**                  |               |    |
| | Rev. 15       |                                | Page 1 of 2   |    |
| +---------------+--------------------------------+---------------+    |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
|   ------------ -------------------                                    |
| -- ------ ----------- ------------ ----------- ---------- ----------- |
|   Name         **     *                                               |
| *             Ext    **     **   Life/Guest   **     **               |
|                                                                       |
|                                  \#                                   |
|                                                                       |
|   Dept 103     National Synchrot                                      |
| ron  Bldg   **     **   Req \#       **     **   Contract   **     ** |
|                Light So                                               |
| urce                                                      \#          |
|                                                                       |
|   Supervisor   **     **                                              |
|      Ext    **     **   Start Date   **     **   End Date   **     ** |
|   ------------ -------------------                                    |
| -- ------ ----------- ------------ ----------- ---------- ----------- |
+-----------------------------------------------------------------------+
|                                                                       |
| -- ------------------ ----------------- -------------------- -------- |
|                                                                       |
|                                                                       |
|      **Human                                                          |
|      Resources**:                                                     |
|      Check-In &                                                       |
|      Orientation                                                      |
|                                                                       |
|      Bldg 400,                            Human Resources      Date   |
|      Brookhaven Avenue                    Signature                   |
|                                                                       |
|                                                                       |
|                                                                       |
|      **BNL Training                                                   |
|      Office**: General                                                |
|      Employee Training                                                |
|      (HP-V-001)                                                       |
|                                                                       |
|      Bldg 400,                            GET Instructor       Date   |
|      Brookhaven Avenue                    Signature                   |
|      -- Given Mondays                                                 |
|      1:00 -- 2:30 PM                                                  |
|                                                                       |
|                                                                       |
|                                                                       |
|      **Badging                                                        |
|      Office**: ID Badge                                               |
|      & Vehicle Sticker                                                |
|                                                                       |
|      Bldg 400,                            Badging/Security     Date   |
|      Brookhaven Avenue                    Signature                   |
|                                                                       |
|                                                                       |
|                                                                       |
|      **NSLS Dept**:                                                   |
|      Check In                                                         |
|                                                                       |
|      Betsy Hanson, Bldg                                               |
|      725B, Room 2-104A,                                               |
|      x7804                                                            |
|                                                                       |
|      Resumé to employee Appointments made                             |
|      file                                                             |
|                                                                       |
|      Personal File Info Copy ID for PC                                |
|      Memo               acct & file                                   |
|                                                                       |
|      R2A2 received      Photo & Intro     NSLS Check-In        Date   |
|                         received          Signature                   |
|                                                                       |
|                                                                       |
|                                                                       |
|      **Supervisor**:    Appt:                                         |
|      Briefing                                                         |
|                                                                       |
|      Meet with          Bldg:       Rm                                |
|                               x                                       |
|                                                                       |
|      Check Training                                                   |
|      boxes on Page 2                                                  |
|                                                                       |
|      R2A2               Photo/Intro to                                |
|      completed/signed   Betsy Hanson                                  |
|                                                                       |
|      Discuss work                         Supervisor's         Date   |
|      location and OJB                     Signature                   |
|      hazards                                                          |
|                                                                       |
|                                                                       |
|                                                                       |
|      **ES&H Staff**:    Appt:                                         |
|      Briefing                                                         |
|                                                                       |
|      Lori Stiegler,                       NSLS ES&H Signature  Date   |
|      Bldg 725D, Room                                                  |
|      2-176, x5366                                                     |
|                                                                       |
|                                                                       |
|                                                                       |
|      **Office           Appt:                                         |
|      Assignment**                                                     |
|                                                                       |
|      Bob Kiss, x3476                      Office Assignment    Date   |
|                                           Signature                   |
|                                                                       |
|                                                                       |
|                                                                       |
|      **Office Key**     Appt:                                         |
|                                                                       |
|      Brian Boyle, Bldg                    Office Key Signature Date   |
|      725D, Room 2-189,                                                |
|      x2750                                                            |
|                                                                       |
|                                                                       |
|                                                                       |
|      **Training         Appt:                                         |
|      Coordinator**                                                    |
|                                                                       |
|      Mary Anne Corwin,                                                |
|      Bldg. 725D, Room                                                 |
|      2-160, x2295                                                     |
|                                                                       |
|      JTAs Assigned      AG200TZ1 NSLS                                 |
|                                                                       |
|      Training Completed AG201TZ1                                      |
|                         NSLS/Shop                                     |
|                                                                       |
|      Register as User   AG202TZ1 East                                 |
|                         Roll Up                                       |
|                                                                       |
|      TLD Required       AG203TZ1 Computer                             |
|                         Rm                                            |
|                                                                       |
|      Encode ID          AG204TZ1 Ready                                |
|      (Permanent)        Room                                          |
|                                                                       |
|      Encode ID (Timed)  AG92TZ1 SDL       Training Coordinator Date   |
|                                           Signature                   |
|                                                                       |
|                                                                       |
|                                                                       |
|      **User             Any time 8 am-12,                             |
|      Administration**   1-4:30 pm                                     |
|                                                                       |
|      Bldg 725B, Rm      Badge encoded                                 |
|      2-100, x8737                                                     |
|                                                                       |
|      Registered as User Temp TLD Issued   User Administration  Date   |
|                                           Signature                   |
|                                                                       |
|                                                                       |
|                                                                       |
|                                                                       |
|                                                                       |
|      **RCD Facility     Appt:                                         |
|      Rep**: Briefing                                                  |
|                                                                       |
|      Frank Zafonte,                                                   |
|      Bldg 725A, Rm                                                    |
|      1-174, x5565, Cell                                               |
|      631-457-3793                                                     |
|                                                                       |
|      Permanent TLD      TLD Location:     RCD Representative   Date   |
|      Issued                               Signature                   |
|                                                                       |
|                                                                       |
|                                                                       |
|      **PC               Appt:                                         |
|      Administrator**:                                                 |
|      Acct/Email                                                       |
|                                                                       |
|      Al Levine, Bldg.                     PC Administrator     Date   |
|      830M, Rm 24, x4707                   Signature                   |
|      (or Peter Gross                                                  |
|      x7337)                                                           |
|                                                                       |
|      BNL ID Received                                                  |
|                                                                       |
|                                                                       |
|                                                                       |
|      **Deputy Chair**:  Appt:                                         |
|      Meeting                                                          |
|                                                                       |
|      Meet with          Bldg:       Rm    Deputy Chair or      Date   |
|                               x           Designee Signature          |
|                                                                       |
|      Discuss                                                          |
|      programmatic and                                                 |
|      ESH roles &                                                      |
|      responsibilities                                                 |
|                                                                       |
|                                                                       |
|                                                                       |
| -- ------------------ ----------------- -------------------- -------- |
+-----------------------------------------------------------------------+
| +------------------------------------------------------------------+  |
| | I completed the ESH Briefing and will abide by BNL and NSLS      |  |
| | safety rules and procedures.                                     |  |
| |                                                                  |  |
| | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_         |  |
| | \_\_\_\_\_\_\_\_                                                 |  |
| |                                                                  |  |
| | Employee/Guest Signature Date                                    |  |
| +------------------------------------------------------------------+  |
+-----------------------------------------------------------------------+

[Return to Betsy Hanson within 2 weeks after start date]{.mark}

cc: Training Coordinator, LS User Administration Office, Employee File

The only official copy of this form is online at the website below.
Verify the date before using this form.

http://www.nsls.bnl.gov/training/orientations/Orientation-Emps-Guests.doc