EXAMPLE: Radiographer Training Documentation

This is to certify that the following individuals have completed training as required in 18 AAC 85.640, including the subjects as listed below:

Training Course Subjects Covered

• 18AAC85.640(1) Fundamentals of Radiation Safety
• 18AAC85.640(2) Ionizing radiation detection instrumentation
• 18AAC85.640(3) Operation and Control of the equipment
• 18AAC85.640(4) Pertinent federal and state regulations
• 18AAC85.640(5) Written operating and emergency procedures

Signatures of Participants

• _______________________________________
• _______________________________________
• _______________________________________
• _______________________________________
• _______________________________________
• _______________________________________
• _______________________________________

Course characteristics:

• Name of instructor:________________________________________
• Qualifications/credentials of instructor:_________________________
• Date(s) of Training:________________________
• Total number of hours completed:______________
• Specific equipment and source(s) referenced in the training: ________________________________________
• NOTE: Attach a copy of the written operating procedures and emergency procedures.