Certification Application for the Certification of NDT Personnel Acc. to DIN EN ISO 9712

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1 for NDT-Personnel Certification Application for the Certification of NDT Personnel Acc. to DIN EN ISO 9712 A. Details of candidate / person to be certified Name surname, first name title Address street, number postcode, town Date / place of birth (business and/or private) B. Details of employer (same as delivery and invoice address) Company name department Address street, number postcode, town telephone, fax * (contact person for further queries) C. Order number / billing address if different / in the case of non-german customers: tax ID number / miscellaneous D. Application for certification Types of application are: Initial certification: Initial certification of a method Expansion of a method (by one level or sector) Extension of certification: Renewal - after approx. 5 years Recertification after approx. 10 years Type of certification (initial, exp., new, recert) Method/Level Sectors (based on examination and documentary evidence of NDT-activity) For initial certification: no. of months industrial NDTexperience (see Details ) PED Certificate number at TÜV Rheinland - if available - The following documentary evidence is to be attached to the application or must be submitted to the CB: Initial certification: Extension: - Confirmation of participation in NDT training - Valid eye test - Documentary evidence of qualification examinations - Doc. evidence cont. professional activity acc. to form - Eye test valid at the point in time of certification - Current photo by to ISO9712@de.tuv.com - Current photo by to ISO9712@de.tuv.com In addition for recertification: - Documentary evidence of recertification examination Please state in which language your ID card should be printed (if no indication is given, card will be printed in German) German English No ID Card ID Card * MANDATORY (This application will not be processed if no address is given!) E_ZA 9712_09_ 2014.doc

2 for NDT-Personnel Certification Application for the Certification of NDT Personnel Acc. to DIN EN ISO 9712 E. Authorisation/sample signature: The signature authorisation is an obligatory requirement for issue of the DIN EN ISO 9712 ID card. With my signature I grant the Certification Body permission to scan my signature which is to be used solely for the DIN EN ISO 9712 ID card. Please sign in the following box: F. Declaration of the employer, supervisor, authorised agent or self-employed person I herewith confirm that I am the employer, supervisor or authorised agent of the candidate to be certified that as a self-employed person I assume the overall responsibility attributed to the employer acc. to Pts and of DIN EN ISO 9712 the correctness of the stated periods of industrial NDT-experience (for initial certification) that are required for certification full and continuous documentation of the annual eye test in acc. with DIN EN ISO 9712 in addiction, for renewal or recertification, the continuous professional activity without significant periods of interruption (see form: Documentary evidence NDT-experience) acc. to Pts b and 3.27 of DIN EN ISO 9712 I herewith instruct the Certification Body to certify the candidate stated above and undertake to bear the costs incurred from certification provided that the costs are not included in the examination fees. Employer/supervisor/ authorised agent or self-employed person / Place, date Signature, company stamp Miscellaneous (please delete or add as applicable)... Name in clear writing G. Declaration of the candidate / person to be certified I herewith affirm that all information I have provided is correct and true. I undertake to comply with and observe the professional ethical regulations for NDT-personnel (see Enclosure 1), as specified by the Certification Body for NDT-Personnel. I acknowledge that - the validity of the certificate is contingent on continuous activity and physical aptitude; - significant periods where work activities are interrupted, e.g. a consecutive period >1 year, lead to the certificate becoming invalid; - incorrect information, any abuse or misuse of the certificate or any violation of the professional ethical principles can lead to revocation of the certificate. - I will inform the Certification Body immediately if information on the certificate is incorrect, if the requirements for certification are no longer complied with, if information relevant to certification, such as e.g. the address or employer, changes - the certificate remains the property of the Certification Body and may be revoked when quoted in a misleading manner or used incorrectly. - TÜV Rheinland do not assume any liability for damages that could result from my activities as a certified person. I agree that - the certification issued be published in a list; - my name, place of birth, date of birth and data relating to the certification issued be stored electronically; - the Certification Body may obtain all information relating to the certification; - the Certification Body be informed immediately of all objections to the certificate issued I indemnify the Certification Body from all claims that may result from improper or incorrect utilisation of the certificate. Candidate: Place, date Name, signature Please send the application with all requisite documents to: If you have any questions about certification please contact: Certification Body Susanne Nolting TÜV Rheinland Werkstoffprüfung GmbH Susanne Nolting Am Grauen Stein, D Köln : or by to: ISO9712@de.tuv.com : susanne.nolting@de.tuv.com Further information on how to fill in this application as well as enclosures and forms are available for download in the Internet. E_ZA 9712_09_ 2014.doc

3 Documentary Evidence NDT-Experience A) Industrial NDT experience for initial certification or B) Continuous professional activity for renewal or recertification Sufficient period of previous experience is prerequisite for admission to examination. It is added to the overall period of experience required for initial certification. Surname and first name of the candidate:... Employee Self-employed* 1 : For A: Place and date of seminar:... As applicable: certificate-no.:... Please use a separate sheet for each method NDT-method / level/ sectors (MT; PT; VT; RT, RT-FI, UT, UT-WD) Description of activity For A: - Period of accumulated experience - Total number of months Date and name (in clear writing) of employer or client, superior or supervisor, Signature, (c, f, w, wp, t) For B: Date of document For B: Name of document Address, company stamp, address Date and signature candidate:... * 1 Self-employed candidates require confirmation from the client in question E_Nachweis_Erfa.doc

4 Enclosure 1 to Certification Application for the Certification of NDT Personnel in Accordance with DIN EN ISO 9712 Ethical Principles Certificate holders must ensure that injury to persons or damage to the environment and property damage are avoided to the best of their knowledge and belief, and that the public interest is safeguarded. They must act in accordance with the latest level of technical standards and their conduct towards all other persons must be honest, incorrupt, loyal and impartial. Public Responsibility The holder of the certificate must safeguard and protect the interests and welfare of the general public during performance of his/her professional NDT activities. This means that he/she informs the responsible bodies, declines certain responsibilities or refuses tasks for which he/she is not qualified. Publications must be professionally, technically and objectively well-founded and only use content for which he/she is qualified by training and experience. He/she may not sign any documents if he/she does not fully understand or approve of the content. Relationship to Employer The contractual relationship to the employer must be regulated in such a manner that the professional ethical principles can be observed. Functions, competence and responsibilities must be clearly defined. Conflicts of Interest Certificate holders should endeavour to avoid conflicts. In such cases, however, where this is unavoidable, the corresponding partners are to be informed promptly and unreservedly about the reason for the conflict. All decisions, actions, assessments or judgements are to be made without any self-interest or personal benefit. Violation of Professional Ethical Regulations Any violation of professional ethical regulations leads to all certificates that have been issued for this person by the Certification Body losing their validity. In this case the certificate must be returned immediately to the Certification Body. Ethical principles.doc As of: March 2013

5 Form Verification of Visual Acuity for NDT Testing Personnel in Accordance with DIN EN ISO 9712 For Mr/Ms... Date of birth... Street... Post code... Town... Country... The following minimum requirements for visual acuity in accordance with DIN EN ISO 9712 are attested: 1. Near Vision The candidate s near vision acuity must be sufficient in order to be able to read Jaeger No. 1 letters or Times Roman N 4.5 or equivalent eye test characters (height: 1.6 mm) at a distance of not less than 30 cm with at least one eye, with or without corrective lenses. 2. Sufficient Colour Vision / Contrast Vision The candidate s colour vision must be sufficient that he/she is capable of distinguishing contrasts or differentiating between colours or shades of grey (e.g. Ishihara test). 3. Far Vision Acuity (ONLY VT personnel) (Distance > 4 m) Value 0.63 with Landolt rings Other type attained in at least on eye Corrective lenses for - near vision are required not required - far vision required not required Ophthalmologist / Optician... Place, date Name, signature Stamp Note: The minimum requirements for visual acuity must have been verified before the qualification examination (see Point 7.1 of DIN EN ISO 9712). For certified personnel according to DIN EN ISO 9712 the following applies: the employer must obtain and maintain the complete written documentation on the annual eye test (see Point 7.4 of DIN EN ISO 9712). Re. point 3: test personnel who perform or evaluate visual inspections must additionally comply with the requirements of DIN EN 13018, Pt. 7c regarding visual acuity. Sample

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