+------------------------+---+---+---+-----------+---+----------+------------+
|                        |   |   |   |           |   |          | R          |
|                        |   |   |   |           |   |          | equisition |
|                        |   |   |   |           |   |          | No./Date   |
+------------------------+---+---+---+-----------+---+----------+------------+
|                        |   |   |   |           |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
|                        |   |   |   |           |   |          |            |
|                        |   |   |   |           |   |          |            |
|                        |   |   |   |           |   |          |            |
|                        |   |   |   |           |   |          |            |
|                        |   |   |   |           |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
| Employee/Guest Name    |   | L |   |           |   | Start    |            |
|                        |   | i |   |           |   | Date     |            |
|                        |   | f |   |           |   |          |            |
|                        |   | e |   |           |   |          |            |
|                        |   | / |   |           |   |          |            |
|                        |   | G |   |           |   |          |            |
|                        |   | u |   |           |   |          |            |
|                        |   | e |   |           |   |          |            |
|                        |   | s |   |           |   |          |            |
|                        |   | t |   |           |   |          |            |
|                        |   | N |   |           |   |          |            |
|                        |   | u |   |           |   |          |            |
|                        |   | m |   |           |   |          |            |
|                        |   | b |   |           |   |          |            |
|                        |   | e |   |           |   |          |            |
|                        |   | r |   |           |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
| Chemistry              |   | C |   |           |   | 555      |            |
|                        |   | O |   |           |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
| Department/Division    |   | D |   |           |   | Bldg.    |            |
|                        |   | e |   |           |   | Number   |            |
|                        |   | p |   |           |   |          |            |
|                        |   | t |   |           |   |          |            |
|                        |   | . |   |           |   |          |            |
|                        |   | / |   |           |   |          |            |
|                        |   | D |   |           |   |          |            |
|                        |   | i |   |           |   |          |            |
|                        |   | v |   |           |   |          |            |
|                        |   | . |   |           |   |          |            |
|                        |   | C |   |           |   |          |            |
|                        |   | o |   |           |   |          |            |
|                        |   | d |   |           |   |          |            |
|                        |   | e |   |           |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
|                        |   |   |   | Diane     |   |          |            |
|                        |   |   |   | Cab       |   |          |            |
|                        |   |   |   | elli/4361 |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
| S                      |   |   |   | ES&H      |   |          |            |
| upervisor/Sponsor/Ext. |   |   |   | Coordin   |   |          |            |
|                        |   |   |   | ator/Ext. |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
| Jean Logan/4391 (Alt.  |   |   |   | Earle     |   |          |            |
| J. Petterson/4301)     |   |   |   | Edw       |   |          |            |
|                        |   |   |   | ards/4308 |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
| Training               |   |   |   | Facility  |   |          |            |
| Coordinator/Ext.       |   |   |   | Support   |   |          |            |
|                        |   |   |   | R         |   |          |            |
|                        |   |   |   | epresenta |   |          |            |
|                        |   |   |   | tive/Ext. |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+
|                        |   |   |   |           |   |          |            |
+------------------------+---+---+---+-----------+---+----------+------------+

Administration

+-----------------------------------+-----------------------------------+
| 1\. General orientation/check-in  |                                   |
| at Human Resources\               |                                   |
| or Facility User\'s Office        |                                   |
| Completed.                        |                                   |
+-----------------------------------+-----------------------------------+
|                                   | Human Resources Signature         |
+-----------------------------------+-----------------------------------+
| 2\. BNL identification/vehicle    |                                   |
| pass issued.                      |                                   |
+-----------------------------------+-----------------------------------+
|                                   | Security Signature                |
+-----------------------------------+-----------------------------------+
| 3\. ES&H Coordinator\'s briefing  |                                   |
| completed.                        |                                   |
+-----------------------------------+-----------------------------------+
|                                   | ES&H Coordinator\'s Signature     |
+-----------------------------------+-----------------------------------+
| 4\. Facility Support              |                                   |
| Representative\'s briefing        |                                   |
| completed.                        |                                   |
+-----------------------------------+-----------------------------------+
|                                   | Facility Support                  |
|                                   | Representative\'s Signature       |
+-----------------------------------+-----------------------------------+
| 5\. [Supervisor\'s                | [Training Coordinator             |
| Section]{.underline}              | Section]{.underline}              |
+-----------------------------------+-----------------------------------+
| a\. Will Radiation Dosimetry be   | d\. Job Training Assessment (JTA) |
| issued? \                         | Code(s) to which employee/guests  |
| yes no                            | should be linked:                 |
|                                   |                                   |
|                                   | GE-53E                            |
+-----------------------------------+-----------------------------------+
| b\. Will individual be working in |                                   |
| areas belonging to\               |                                   |
| another department? \             |                                   |
| yes no                            |                                   |
+-----------------------------------+-----------------------------------+
| c\. If yes, list working          |                                   |
| Department, Location, and Contact |                                   |
| Name.                             |                                   |
|                                   |                                   |
|                                   |                                   |
|                                   |                                   |
| e\. Supervisor\'s briefing on     |                                   |
| job- and work- location-specific\ |                                   |
| hazards completed.                |                                   |
+-----------------------------------+-----------------------------------+
|                                   | JTA Codes for Employee/Guest      |
|                                   |                                   |
|                                   | Training Coordinator briefing on  |
|                                   | training requirements.            |
+-----------------------------------+-----------------------------------+
| Supervisor\'s Signature           | Training Coordinator\'s Signature |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+

General Employee/Radiological Training

<table>
<colgroup>
<col style="width: 25%" />
<col style="width: 23%" />
<col style="width: 9%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 7%" />
<col style="width: 2%" />
<col style="width: 10%" />
<col style="width: 2%" />
<col style="width: 12%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2"></td>
<td></td>
<td colspan="3">Supervisor's<br />
Initials</td>
<td></td>
<td>Date<br />
Scheduled</td>
<td></td>
<td>Instructor's<br />
Initials</td>
</tr>
<tr class="even">
<td colspan="2">General Employee Training (GET) V001</td>
<td></td>
<td colspan="2">X</td>
<td>Required<br />
for all</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">Hazard Communication (HAZCOMM) IND-200</td>
<td></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">Or</td>
<td></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">Laboratory Standard (Lab Std.) IND-220</td>
<td></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">Or</td>
<td colspan="8"></td>
</tr>
<tr class="odd">
<td colspan="2">Neither Hazard Communication nor Laboratory Standard is
required.</td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="8"><p>Supervisor's Signature</p>
<p>Date</p></td>
</tr>
<tr class="odd">
<td colspan="2" rowspan="7"><p>General Employee Radiological Training
(GERT) RWT-001<br />
or</p>
<p>Radiological Worker I (RW1) RWT-002 (Prerequisite for the
following)<br />
Activation RWT-200<br />
Contamination/High Contamination RWT-300<br />
High/Very High Radiation Area RWT-400<br />
Bench-top Dispersibles RWT-500<br />
or</p></td>
<td rowspan="2"></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"><strong>     </strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>No Radiological training is required</td>
<td colspan="3"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="9">Supervisor's Signature Date</td>
</tr>
<tr class="even">
<td colspan="4">Previous BNL Safety training is valid. (Indicate valid
courses and completion dates in appropriate spaces.)</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3">Training Coordinator's Signature Date</td>
<td colspan="6"></td>
</tr>
</tbody>
</table>

Additional Required Training

  ---------------- --------------------------- -------------- ------------
  Employee/Guest                               Requisition         
  Name                                         No./Date       

  ---------------- --------------------------- -------------- ------------

Schedules and course information is available at http://training.bnl.gov
or from your Training Coordinator.

+--------------------------------------------+--------+--------+-------+
| **Common Course Requirements**             | **Su   | *      | **C   |
|                                            | pervis | *Date\ | omple |
|                                            | or\'s\ | Sched  | tion\ |
|                                            | Init   | uled** | D     |
|                                            | ials** |        | ate** |
+--------------------------------------------+--------+--------+-------+
| Emergency Planning and Response            | X      | \*\*   |       |
| (GE-EMERGPLAN)                             |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Environmental Protection Training          | X      | \*\*   |       |
| (GE-ENV-GET)                               |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Counterintelligence Awareness (GE-CIA)     | X      | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Cyber Security Training (GE-CYBERSEC)      | X      | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Hazardous Waste Generator (HP-RCRIGEN3)    |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Radioactive Waste Generator (HP-RADIGEN)   |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| HAZWOPER (Specify: 24 hour, 40 hour, 8     |        |        |       |
| hour Supervisor)                           |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Basic Electrical Safety (HP-OSH-150A)      |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Electrical Safety 1 (HP-OSH-150B)          |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Lock-out/Tag-Out Affected Worker           |        |        |       |
| (HP-OSH-151A)                              |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Lock-out/Tag-Out Authorized Worker         |        | \*\*   |       |
| (HP-OSH-151B)                              |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Cardiopulmonary Resuscitation (specify:    |        |        |       |
| Adult CPR/ Profess. Rescuer)               |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Back Safety (HP-IND-010)                   |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Forklift Operator/Practical (HP-Q001/A)    |        |        |       |
| medical exam prerequisite                  |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Crane Operator/Practical (HP-Q010/A)       |        |        |       |
| medical exam prerequisite                  |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Basic Rigging for Crane Operators          |        |        |       |
| (HP-GST-155)                               |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Noise and Hearing Conservation             |        |        |       |
| (HP-IND-008) medical exam prerequisite     |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Bloodborne Pathogens (TQ-BBP) medical exam |        | \*\*   |       |
| prerequisite                               |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Regulated Medical Waste Management         |        | \*\*   |       |
| (TQ-RMWM)                                  |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Respirator Training (specify: APR/PAPR,    |        | \*\*   |       |
| SCBA, Airline) Also requires Fit Test:     |        |        |       |
| HP-IND-317 and medical exam prerequisite.  |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Compressed Gas Safety (TQ-COMPGAS)         |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Cryogen Safety (HP-OSH-025)                |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Laser Safety (HP-IND-011) medical exam     |        | \*\*   |       |
| prerequisite                               |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Confined Space Entry (HP-OSH-016)          |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Oxygen Deficiency Hazard (TQ-ODH or        |        | \*\*   |       |
| TQ-ODH1)                                   |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Lead in the Workplace (TQ-LEAD1)           |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Static Magnetic Fields (TQ-SMF)            |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Practical Fire Extinguisher Training       |        |        |       |
| (HP-FRF-101)                               |        |        |       |
+--------------------------------------------+--------+--------+-------+
| VDT Safety (HP-IND-004)                    |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Machine Shop Safety (Dept. Number)         |        |        |       |
+--------------------------------------------+--------+--------+-------+
| Lyme Disease Awareness (TQ-LYME1)          |        | \*\*   |       |
+--------------------------------------------+--------+--------+-------+
| Lab Animal Training MO-002                 |        |        |       |
+--------------------------------------------+--------+--------+-------+
|                                            |        |        |       |
+--------------------------------------------+--------+--------+-------+
|                                            |        |        |       |
+--------------------------------------------+--------+--------+-------+
| SOPs for Handling Controlled Substances    |        |        |       |
| Training                                   |        |        |       |
|                                            |        |        |       |
| [http://www.bnl.gov/medical/CRC%20Po       |        |        |       |
| licies%20Manual/index.htm](http://www.bnl. |        |        |       |
| gov/medical/CRC Policies Manual/index.htm) |        |        |       |
|                                            |        |        |       |
| e-mail: <emerick@bnl.gov> when completed   |        |        |       |
+--------------------------------------------+--------+--------+-------+
| **Circle Needed Location Access:**         |        |        |       |
|                                            |        |        |       |
| -   Collider-Accelerator Complex Access    |        |        |       |
|     (AD-CA_ACCESS)                         |        |        |       |
|                                            |        |        |       |
| -   AGS (AD-USER-FIXTRG)                   |        |        |       |
|                                            |        |        |       |
| -   RHIC (AD-CA_ACCEL_USER)                |        |        |       |
|                                            |        |        |       |
| -   NSLS                                   |        |        |       |
+--------------------------------------------+--------+--------+-------+

\*\* Computer-based training option is available on the Web at
http://training.bnl.gov

**When the activities have been completed, return this form to your
Training Coordinator.**