MQSA Physicist Qualifications Greg Sackett, M.S., CHP. Contents
|
|
|
- Joan Poole
- 6 years ago
- Views:
Transcription
1 Integrated Science Support, Inc 2027 N. 36 th Street St. Joseph, MO (816) (800) MQSA Physicist Qualifications Greg Sackett, M.S., CHP Contents FDA Mammography Physicist Qualification Certificate Missouri Qualified Expert Certificate Missouri Mammography Physicist Initial Qualifications Certificate Iowa Mammography Physicist Certificate Initial Training Digital Mammography Continuing Education Continuing Experience Note: The Missouri Initial Qualifications Certificate does NOT have an expiration date. Distributed January 2014
2 The Individual Below Is Hereby Recognized by the Missouri Department of Health and Senior Services, Bureau of Ambulatory Care as a Qualified Expert in Radiation Safety Greg Sackett MS, CHP Recognition of Qualified Expert Status Valid 12/10/2012 Until: 12/14/2014 Qualified Expert ID: QE047 Administrator, Bureau of Ambulatory Care Area(s) of Expertise Health Physics Consultation Radiation Shielding Design Diagnostic Radiographic (Medical/Chiropractic/Podiatric) Fluoroscopy/Inverventional Radiology Non-Medical/Industrial/Academic/Research Therapy/Linear Accelerator Mammography *(FDA MQSA Standards CT Bone Density/DEXA Dental (Non-CBCT) Veterinary Radiology Other : *MRCP has determined that this Qualified Expert currently meets FDA's MQSA standards for approval as a mammography medical physicist, and a copy of his/her current qualifications is maintained by the MRCP. Per requirements in 19 CSR , this person is found to have the necessary training and experience to be able to perform dependable radiation surveys. Despite recognition of this person's status as a Qualified Expert, the Department makes no warranty either expressed or implied as to the quality of specific services provided to an individual facility. Complaints regarding this person's ability to continue to conduct dependable radiation surveys may be directed to the Radiation Control Program at or MRCP@health.mo.gov
3 Missouri Department of Health and Senior Services P.O. Box 570, Jefferson City, MO Phone: FAX: RELAY MISSOURI for Hearing and Speech Impaired VOICE Margaret T. Donnelly Director Jeremiah W. (Jay) Nixon Governor May 10, 2012 Qualifications Review of Individuals Providing Medical Physics Support Services in Mammography Missouri Rule 19 CSR authorizes the Missouri Department of Health and Senior Services (DHSS) to approve individuals providing medical physics support to suppliers of mammography services. DHSS s Missouri Radiation Control Program (MRCP) has reviewed documentation for: Name: Gregory D. Sackett, M.S., CHP Company or Title: Integrated Science Support Address: 2027 N. 36 th Street City/State/Zip Code: St. Joseph MO Review of Initial Qualifications Initial Requirement Documentation Required by FDA Documents Reviewed/On File at MRCP License, Approval or Board Certified State License, State Approval Letter or ABR/AOBR Certificate in Diagnostic Physics Missouri Dept. of Health & Senior Services State Approval Letter May 10, 2012 Qualifying Degree Specialized Survey Training* Initial Experience* New Modality Training (if applicable) Degree in Physical Science: PhD or MS with 20 hours in Physics PhD or MS Degree: 20 contact hours PhD or MS Degree: 1 facility and 10 units Certificate(s) documenting 8 hours modality-specific training prior to surveying in that modality M.S. in Health Physics Texas A&M University August 12, 1995 *Individual may attest to fulfilling this requirement if training and/or experience obtained prior to October 1, MISSOURI APPROVAL IS GRANTED Start Date: May 10, 2012 Letter from Stephen E. Hale, Ph.D. documenting Mr. Sackett completed 20 contact hours of training in surveying mammography facilities. April 26, 2012 Letter from Stephen E. Hale, Ph.D. documenting Mr. Sackett surveyed, under direct supervision, one (1) facility and ten (10) mammography units. April 26, 2012 Letter from Stephen D. Hale, Ph.D. documenting Mr. Sackett received eight (8) hours of training in surveying digital mammography units. April 26, 2012 Documentation of your continuing education and experience was reviewed and found to be acceptable. Remember that documentation of continuing education and experience must be kept on file at all facilities where you provide medical physics services. Inform MRCP of any changes in name, address or telephone number. Please note FDA has decreed this review/approval is not reciprocal between states. You will need a similar review by each state in which you provide these services. You can also send your documentation directly to FDA for their review. If you have any questions or need additional information, please contact the Missouri Radiation Control Program at (573) Review performed by: Charles C. Arnold FDA Certified MQSA Inspector #I2227 Missouri Radiation Control Program Bureau of Health Services Regulation Healthy Missourians for life. The Missouri Department of Health and Senior Services will be the leader in promoting, protecting and partnering for health. AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER: Services provided on a nondiscriminatory basis.
4 Mariannette Miller-Meeks, B.S.N., M.Ed., M.D. Director Terry E. Branstad Governor Kim Reynolds Lt. Governor March 19, 2013 Greg Sackett Integrated Science Support 2027 North 36 th Street St. Joseph, Missouri Dear Mr. Sackett, This letter is to verify that you have met the Iowa registration requirements for a medical physicist in: Mammography: Digital Tomosynthesis Therefore, you are permitted to perform all those procedures required under Iowa Radiation machines and Radioactive Materials Rules for the above category. This registration expires April 28, Each facility where you provide medical physics services must have a copy of your Medical Physics Approval letter. Thank you for your cooperation. Please call for mammography or for radiation therapy if you have any questions. Sincerely, Melanie Rasmusson, Bureau Chief Iowa Bureau of Radiological Health (515) Fax ( mrasmusson@idph.state.ia.us Lucas State Office Building, 321 E. 12th Street, Des Moines, IA DEAF RELAY (Hearing or Speech Impaired) 711 or
5 Integrated Science Support, Inc 2027 N. 36 th Street St. Joseph, MO (816) (800) May 10, 2012 To: Whom It May Concern From: Stephen E. Hale Jr., Ph.D. Subject: Initial MQSA Training Requirements for Gregory D. Sackett, MS, CHP This memo is to certify that between the dates of January 11, 2012, and April 26, 2012, Gregory D. Sackett, MS, CHP, received 20 contact hours of training in the surveying of mammography x-ray systems. This memo is also to certify that during the same period of time he performed 10 mammography inspections under the direct supervision of Stephen E. Hale Jr., Ph.D. This memo is also to certify that during the same period of time he received 8 hours of training in surveying digital mammography units. This training was conducted by Stephen E. Hale Jr., Ph.D. The records of this training and experience are available in the corporate offices of Integrated Science Support, Inc., at 2027 N. 36 th Street, Saint Joseph, MO
6 Hereby awards this Certificate of Completion to Greg Sackett, M.S., CHP For completing 3 hours of HOLOGIC s Online Tomosynthesis Training For Medical Physicists in accordance with MQSA guidance for Digital 3-D Mammography Systems* Selenia Dimensions Quality Control and Set-up Procedures On this Date: February 22, 2012 Authorized by: VP, Product and Clinical Education, Breast Health * MQSA guidelines require each Medical Physicist to complete eight hours of product training prior to using the Selenia Dimensions for clinical use.
7
8
9 Integrated Science Support, Inc North 36th Street St. Joseph, MO The following is a true representation of the Continuing Mammography System Evaluation Experience for the indicated Physicist. Jon J. Erickson, Ph.D President 1/8/2014 Date Continuing Experience Summary for Greg Sackett, M.S., CHP Facility State MQSA Number System Model Date Performed KS Sonographe Essential 1/11/2012 KS DMR/Fuji CR 1/16/2012 KS Hologic Lorad Selenia 1/17/2012 KS Hologic Lorad Selenia 1/24/2012 KS Diamond w/ Fuji CR 2/13/2012 KS Selenia 2/14/2012 KS Senographe 2000D 2/21/2012 KS Senographe DS 3/20/2012 KS Lorad Selenia 4/24/2012 KS Selenia 4/26/2012 KS Senographe Essential 6/25/2012 KS Lorad Selenia 7/26/2012 KS Sonographe Essential 1/16/2013 KS Selenia 2/12/2013 KS Senographe DS 3/13/2013 KS Lorad Selenia 4/17/2013 KS Selenia 4/24/2013 KS Selenia 4/24/2013 KS Senographe Essential 6/21/2013 KS Lorad Selenia 9/17/2013 KS Lorad Selenia 9/26/2013 KS Lorad Selenia 9/26/2013
10 Facility State MQSA Number System Model Date Performed KS DMR/Fuji CR 1/6/2014 MO Senographe Essential 2/16/2012 MO Senographe Essential 3/24/2012 MO Affinity Platinum/Fuji FCR 4/25/2012 MO Senographe Essential 6/7/2012 MO Selenia 6/15/2012 MO Lorad Selenia 6/21/2012 MO Senographe DS 8/9/2012 MO Senographe Essential 8/10/2012 MO Selenia Dimensions 10/5/2012 MO Lorad M-IV/Fuji CR 10/8/2012 MO Lorad Selenia 11/6/2012 MO Lorad Selenia Dimensions 11/14/2012 MO Lorad Selenia 11/26/2012 MO Lorad Selenia 11/30/2012 MO Senographe Essential 12/3/2012 MO Senographe Essential 6/13/2013 MO Selenia 6/24/2013 MO Senographe DS 8/12/2013 MO Senographe DS 8/14/2013 MO Senographe Essential 8/15/2013 MO Selenia 9/12/2013 MO Lorad M-IV/Fuji CR 10/2/2013 MO Lorad Selenia 11/4/2013 MO Lorad Selenia 11/11/2013 MO Lorad Selenia 11/11/2013 MO Lorad Selenia 11/12/2013 MO Lorad Selenia 11/12/2013 MO Lorad Selenia 11/20/2013 MO Lorad Selenia Dimensions 11/20/2013 MO Senographe DS 12/13/2013 MO Senographe Essential 12/16/2013
11 Facility State MQSA Number IA Facilities: 0 IA Machines: 0 System Model Date Performed KS Facilities: 12 KS Machines: 23 MO Facilities: 15 MO Machines: 31
Introduction. FDA Approval. Breast Tomosynthesis From the Ground Up
Breast Tomosynthesis From the Ground Up Bill Geiser, MS DABR Senior Medical Physicist wgeiser@mdanderson.org 1 Introduction Why Breast Tomosynthesis? Facility Design Requirements PACs and Storage Requirements
The Mammography Quality Standards Act Final Regulations Inspection Questions
Compliance Guidance The Mammography Quality Standards Act Final Regulations Inspection Questions Document issued on November 5, 1999 U.S. Department Of Health And Human Services Food and Drug Administration
Fluoroscopy Testing Workshop
Hands-on Fluoroscopy Testing Workshop 2-day Workshop February 24-25, 2018 in Wichita, KS 4.5 SAMs offered A continuing education division of HERZING UNIVERSITY Workshop Schedule ~~~~ Day One ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Continental Manufacturing Chemist, Inc. 12/21/17
Continental Manufacturing Chemist, Inc. 12/21/17 Division of Pharmaceutical Quality Operations III 300 River Place, Suite 5900 Detroit, MI 48207 Telephone: (313) 393-8100 Fax: (313) 393-8139 December 21,
3/6/2017 TOMOSYNTHESIS GUIDED BREAST BIOPSY LEARNING OBJECTIVES DISCLOSURES
TOMOSYNTHESIS GUIDED BREAST BIOPSY Amy Kerger, D.O. Assistant Professor The Ohio State Wexner Medical Center Stefanie Spielman Comprehensive Breast Center LEARNING OBJECTIVES What is the difference between
Title (Mr., Miss, Mrs., etc.): Last Name: First Name: Middle Name: Suffix (II, Jr., etc.): Maiden/Previous Last Name:
Please complete, sign, and date the application. You will not receive your Notice to Schedule (NTS) email unless all of the information is complete and payment is received. Please ensure that your email
*Note: A new application is required for change in the business address or ownership.
Iowa Department of Inspections and Appeals Food and Consumer Safety Bureau Unattended Food Establishment License Application *Note: A new application is required for change in the business address or ownership.
Pennsylvania s Radiation Protection Program
Pennsylvania s Radiation Protection Program David J. Allard, CHP CAC Meeting February 20, 2018 Tom Wolf, Governor Patrick McDonnell, Secretary PA Radiation Protection Program Objectives of this presentation:
Risk Based Incoming Quality Assurance (IQA)
Microrite, Inc. brings you this unique learning experience in Risk Based Incoming Quality Assurance (IQA); Part of Microrite s step-by-step webinar series. Risk Based Incoming Quality Assurance (IQA) In
PICKENS COUNTY BUILDING CODES SPECIAL INSPECTION PROCEDURE IBC CHAPTER EDITION
PICKENS COUNTY BUILDING CODES SPECIAL INSPECTION PROCEDURE IBC CHAPTER 17 2012 EDITION When Required All projects that require a SC licensed Architect or Engineer per SC Architectural and Engineering registration
Credit Application. JMF Company and Subsidiaries nd St. Ct. Fax: (563)
Credit Application 2735 62nd St. Ct. Fax: (563) 332-2799 Email: credit@jmfcompany.com Please complete the following and fax or email back to JMF. Company Name: City/State/Zip: Phone Number: Requested Credit
MARYLAND DEPARTMENT OF THE ENVIRONMENT PROPOSED CALENDAR YEAR 2017 STANDARD PERMIT APPLICATION TURNAROUND TIMES
MARYLAND DEPARTMENT OF THE ENVIRONMENT PROPOSED CALENDAR YEAR 2017 STANDARD PERMIT APPLICATION TURNAROUND TIMES As required by Section 1-607(A)(2) of the Environment Article, the Maryland Department of
Version No: 1.0 Approved by: Helen Johnson Approved on: 3/29/2018. CEM Exam with Live In-House Seminar Version
Page 1 of 8 Effective 4/1/2018 CEM APPLICATION CEM Exam with Live In-House Seminar Version Please use this form only if you plan on taking the CEM Certification Exam held in-conjunction with one of the
ENGINEERING MANAGER Salary Range: $9,021 - $12,088
ENGINEERING MANAGER Salary Range: $9,021 - $12,088 San Lorenzo Valley Water District is looking for applicants for the position of Engineering Manager. Please read the details of the position and how to
DONATED LEAVE APPLICATION INSTRUCTIONS PLEASE FOLLOW THE INSTRUCTIONS BELOW TO COMPLETE THE DONATED LEAVE APPLICATION PROCESS
DONATED LEAVE APPLICATION INSTRUCTIONS PLEASE FOLLOW THE INSTRUCTIONS BELOW TO COMPLETE THE DONATED LEAVE APPLICATION PROCESS 1. Applicant must complete the attached Donated Leave application and have
President-Elect. Regis A. Greenwood, C H P Inletridge Drive Maryland Heights, MO
President-Elect Regis A. Greenwood, C H P 12332 Inletridge Drive Maryland Heights, MO 63043-2049 314-205-8441 greenwood@physicist.net A Certified Health Physicist with 41 years experience. For the last
WARNING LETTER CERTIFIED MAIL RETURN RECEIPT REQUESTED. Reference No. 06-HFD
Food and Drug Administration Rockville, MD 20857 WARNING LETTER CERTIFIED MAIL RETURN RECEIPT REQUESTED Reference No. 06-HFD-45-0602 Massimo Cristofanilli, M.D. MD Anderson Cancer Center 1515 Holcombe
Radiology Equipment and Reports
Section 2 Radiology Equipment and Reports Contents Risk Assessment RPII Licence of Equipment Inventory of Radiation Equipment Criteria of Acceptability Setting and Reviewing Nominal Replacement Dates National
Proposal to Provide Interpreter Services Program: Service Area I submitted April 20th, 2012
Proposal to Provide Interpreter Services Program: Service Area I submitted April 20th, 2012 Presented to: Washington State Health Care Authority Our Mission: We exist to be the trusted communication link
Radiation Protection Program Updates
Radiation Protection Program Updates SWEP Capital Chapter Seminar November 2, 2017 Bryan Werner Decommissioning and Environmental Surveillance Manager Tom Wolf, Governor Patrick McDonnell, Secretary Radiation
Examination Suspension effective from July 1, 2012 to June 30, 2016 A completed application must be received no later than June 30, 2016.
Commonwealth of Virginia Department of Professional and Occupational Regulation 9960 Mayland Drive, Suite 400 Richmond, Virginia 23233-1485 (804) 367-8595 www.dpor.virginia.gov Board for Waterworks and
DEVELOPMENT SERVICES PO Box 1110 Tampa, FL Date: May 12, Interested Parties. John L. Barrios, CBO, Building Official
DEVELOPMENT SERVICES PO Box 1110 Tampa, FL 33601-1110 DEVELOPMENT SERVICES DEPARTMENT Date: May 12, 2017 To: From: SUBJECT: Interested Parties John L. Barrios, CBO, Building Official THRESHOLD BUILDINGS
CUSTOMER SERVICE REPRESENTATIVE I/II Salary Range: $4,523 $6,061
CUSTOMER SERVICE REPRESENTATIVE I/II Salary Range: $4,523 $6,061 DEFINITION Under the general supervision of the Director of Finance & Business Services, performs a wide variety of clerical and accounting
Eric W. Abelquist, Ph.D., CHP President, Health Physics Society. August 2017
Careers in Health Physics Eric W. Abelquist, Ph.D., CHP President, Health Physics Society August 2017 What Is Health Physics? Study of radiation and its effects on people Multidisciplinary Physics Biology
Office of MN.IT Services
O L A OFFICE OF THE LEGISLATIVE AUDITOR STATE OF MINNESOTA FINANCIAL AUDIT DIVISION REPORT Office of MN.IT Services Billings for Agency-Based Information Technology Services Internal Controls and Compliance
Supplier Registration Form Maryland and District of Columbia
Supplier Registration Form Maryland and District of Columbia The data provided on this form will be used to establish a Supplier record and Supplier ID number with Pepco. Please send the completed executed
CITY OF BURLESON. 141 West Renfro Burleson, Texas TEL: (817) FAX: (817) Web Address:
CITY OF BURLESON 141 West Renfro Burleson, Texas 76028 TEL: (817) 426-9640 FAX: (817) 295-9414 Web www.burlesontx.com AN EQUAL OPPORTUNITY EMPLOYER APPLICATION FOR EMPLOYMENT PLEASE READ FIRST: Thank you
Norfolk Medical Group, LLC Application for Employment
Norfolk Medical Group, LLC Application for Employment It is our policy to provide equal employment opportunities to all qualified persons without regard to race, color, religion, sex, national origin,
NORTH CAROLINA VETERINARY MEDICAL BOARD PRACTICE INSPECTION 1611 Jones Franklin Road, Suite 106, Raleigh NC (919) FAX (919)
NORTH CAROLINA VETERINARY MEDICAL BOARD PRACTICE INSPECTION 1611 Jones Franklin Road, Suite 106, Raleigh NC 27606 (919) 854-5601 FAX (919) 854-5606 FOR OFFICE STAFF ONLY Photo(s): $125.00 Inspection Fee
CALHOUN COUNTY TREASURER S OFFICE EMPLOYMENT CLASSIFICATION
CALHOUN COUNTY TREASURER S OFFICE EMPLOYMENT CLASSIFICATION TITLE: Clerk Driver s License, Motor Vehicle and Tax GENERAL DESCRIPTION Under close supervision, performs routine issuing of driver s license,
CALHOUN COUNTY TREASURER S OFFICE EMPLOYMENT CLASSIFICATION
CALHOUN COUNTY TREASURER S OFFICE EMPLOYMENT CLASSIFICATION TITLE: Clerk Driver s License, Motor Vehicle and Tax GENERAL DESCRIPTION Under close supervision, performs routine issuing of driver s license,
Quality Assurance QA STANDARD OPERATING PROCEDURE FOR FDA or Pharmaceutical Sponsored Audits
Quality Assurance QA 601.01 STANDARD OPERATING PROCEDURE FOR FDA or Pharmaceutical Sponsored Audits Approval: Nancy Paris, MS, FACHE President and CEO 24 May 2017 (Signature and Date) Approval: Frederick
PUBLIC NOTICE MARYLAND DEPARTMENT OF TRANSPORTATION NOTICE ARCHITECTS & ENGINEERS TRANSPORTATION PROFESSIONAL SERVICES SELECTION BOARD
PUBLIC NOTICE MARYLAND DEPARTMENT OF TRANSPORTATION NOTICE TO ARCHITECTS & ENGINEERS TRANSPORTATION PROFESSIONAL SERVICES SELECTION BOARD REQUEST FOR PROFESSIONAL SERVICES The Secretary of the Maryland
The FDA/CDRH Perspective in the Regulation of Surgical Mesh
The FDA/CDRH Perspective in the Regulation of Surgical Mesh David Krause, Ph.D., Branch Chief Plastic & Reconstructive Surgery Branch Division of Surgical, Orthopedic & Restorative Devices Office of Device
FOOD AND DRUGS AUTHORITY
FOOD AND DRUGS AUTHORITY APPLICATION FORM FOR REGISTRATION OF MEDICAL DEVICES Document No. : FDA/MCH/MDD/AP-IMD/2013/02 Date of First Adoption : 1st February, 2013 Date of Issue : 1st March, 2013 Version
Disclosures. I am a member of the Onyx speaker bureau (topic = sorafenib) I am a paid consultant to
Disclosures I am a member of the Onyx speaker bureau (topic = sorafenib) I am a paid consultant to Boston Scientific IVC filters, oncology CeloNova Embolization Cook Embolization MDS Nordion Radioembolization
SOUTHERNARKANSAS UNIVERSITYTECH P.O. BOX3499 CAMDEN, AR PHONE: (870) FAX: (870)
SOUTHERNARKANSAS UNIVERSITYTECH P.O. BOX3499 CAMDEN, AR 71711 PHONE: (870) 574-4481 FAX: (870) 574-4489 E-mail: humanres@sautech.edu Dear Applicant: Thank you for your inquiry about the position at Southern
BREASTSCREEN VICTORIA INC POSITION DESCRIPTION. FULL TIME, PART TIME or other by negotiation
BREASTSCREEN VICTORIA INC POSITION DESCRIPTION POSITION TITLE: REPORTS TO: EMPLOYMENT BASIS: EMPLOYMENT STATUS: Radiographer, Mobile Screening Service Mobile Screening Service Manager FULL TIME, PART TIME
SCOPE OF ACCREDITATION. NonDestructive Testing. Veridiam Inc Cuyamaca St El Cajon, CA 92020
SCOPE OF ACCREDITATION NonDestructive Testing Veridiam Inc. 1717 Cuyamaca St El Cajon, CA 92020 This certificate expiration is updated based on periodic audits. The current expiration date and scope of
I. BUSINESS INFORMATION
APPLICATION FOR THE FIELD OF INSTRUCTIONS 1. Use Capital Letters 2. Cross the applicable boxes 3. Use extra sheet, where necessary 4. Elaborate the entries, if marked OTHER 5. Attach photocopies of all
Auditing Microbiology Media Suppliers
Microrite, Inc. brings you this unique learning experience in Auditing Microbiology Media Suppliers; Part of Microrite s step-by-step webinar series. Auditing Microbiology Media Suppliers More often than
REGULATION REGARDING EQUIPMENT PROCUREMENT PROCESS AND APPROVAL OF MANUFACTURERS FOR NUCLEAR FACILITIES
REGULATION REGARDING EQUIPMENT PROCUREMENT PROCESS AND APPROVAL OF MANUFACTURERS FOR NUCLEAR FACILITIES SECTION ONE Purpose, Scope, Basis, Definitions and General Considerations Purpose and scope ARTICLE
FRANCO CONSULTING ENGINEERS, LLC
FRANCO CONSULTING ENGINEERS, LLC Franco Consulting Engineers (FCE) is a DBE and MBE certified consulting engineering firm qualified to provide professional services in Highway Design, Project Consulting,
Limon School District RE-4J
. Limon School District RE-4J Board of Education Craig Bailey, President Mike Hines, Vice President Wendy Pottorff, Secretary Theron Perry, Treasurer Jason Bandy, Director January, 2018 Thank you for your
WARNING LETTER VIA FEDERAL EXPRESS CIN
y..iii j DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Cincinnati District Office Central Regio n 6751 Steger Drive Cincinnati, OH 45237-3097 Telephone : (513) 679-2700 FAX : (513)
Radiology Staffing Survey 2010
Radiology Staffing Survey 2010 A Nationwide Survey of Registered Radiologic Technologists Conducted by the American Society of Radiologic Technologists Reported June 2010 2010 ASRT. All rights reserved.
RADIATION PROCEDURES MANUAL
RADIATION PROCEDURES MANUAL Procedure Cover Sheet Procedure Title: Radiation Use Application Procedure Number: TSO-00-17-REV 3 Date: September 17, 2010 Procedure #: TSO-10-17-REV 3 Procedure Title: RADIATION
WORKFORCE CONNECTIONS, INC. GRIEVANCE PROCEDURES
WORKFORCE CONNECTIONS, INC. GRIEVANCE PROCEDURES Updated 10/31/16 Workforce Connections, Inc. employment applicants, employees, program applicants and program participants have the right to enter into
NICET Technician Upgrade Application Instructions General Knowledge Programs
NICET Technician Upgrade Application Instructions General Knowledge Programs General Instructions/Procedures In order to upgrade in a General Knowledge program, the applicant must hold an active-status
HARMONIZATION OF RADIATION SAFETY. Emerging challenges in the management of medical exposures Views from PAHO, WHO, EC, IAEA
HARMONIZATION OF RADIATION SAFETY Emerging challenges in the management of medical exposures Views from PAHO, WHO, EC, IAEA IRPA 12. Buenos Aires, October 2008 Pablo Jiménez Regional Advisor in Radiological
GILLESPIE COUNTY, TEXAS EMPLOYMENT APPLICATION
For Internal Use Only... Received application on: AN EQUAL OPPORTUNITY EMPLOYER Gillespie County complies with State and Federal Laws as to non-discrimination against any person in job structuring, recruitment,
Documentary Evidence Assessment Application Form
1. Documentary Evidence Assessment Application Form Part 1: Personal Details Mr Ms Mrs Miss Surname: Given Names: Date of birth: Indeterminate Gender: Male Female Intersex Unspecified Country of Citizenship:
Clear Creek Fire Authority Firefighter Application
Clear Creek Fire Authority Firefighter Application Your completed application should be returned by mail, email or fax to: Clear Creek Fire Authority Attention: Recruiting PO Box 507 681 County Road 308
WORKFORCE CONNECTIONS, INC. GRIEVANCE PROCEDURES
WORKFORCE CONNECTIONS, INC. GRIEVANCE PROCEDURES Updated 4/6/16 Workforce Connections, Inc. employment applicants, employees, program applicants and program participants have the right to enter into the
Apprenticeship Standards. Standards of Apprenticeship
Apprenticeship Standards Standards of Apprenticeship Commonwealth of Massachusetts Department of Labor Standards Division of Apprentice Standards Employer Program Sponsor Formulated By: Company: Manufacturing
Dear Family Peer Support Specialist (FPSS) Applicant:
Dear Family Peer Support Specialist (FPSS) Applicant: Thank you for your interest in FPSS certification through the Iowa Board of Certification (IBC). IBC credentials prevention and treatment professionals
Table 1 Summary of Analytical Test Results. Material Location Material Description Result Category. Small Mudded Fittings (on 1 to 4 diameter piping)
June 10, 2015 Ms. Marsha Smith, P.E. University of Missouri Campus Facilities Project Management 111 General Services Building Columbia, Missouri 65211 RE: Asbestos Survey Report - Sub-Basement, Mechanical
Study Start-Up SS STANDARD OPERATING PROCEDURE FOR Investigator Selection
Effective date of version: April 01, 2012 Study Start-Up SS 202.00 STANDARD OPERATING PROCEDURE FOR Investigator Selection Approval: Nancy M. Paris, MS, FACHE President and CEO 08 March 2012 (Signature
ADDENDUM #1 Construction Support Services for the Water Treatment Plant Project PW
January 31, 2018 To Whom It May Concern: I. INSTRUCTIONS ADDENDUM #1 Construction Support Services for the Water Treatment Plant Project 18-0018PW A. The following additions, deletions, revisions, and/or
PACS A WEB-BASED APPLICATION DESIGNED TO AUTOMATE YOUR WORKFLOW
A WEB-BASED APPLICATION DESIGNED TO AUTOMATE YOUR WORKFLOW About us Our Company Our Mission is Simple Our company is Canadian and was established in 1994. After over 20 years, we continue to be a leading
February 1, Dear Potential Intoxicated Driving Program (IDP) Residential Affiliated Provider:
CHRIS CHRISTIE Governor KIM GUADAGNO Lt. Governor DEPARTMENT OF HUMAN SERVICES DIVISION OF MENTAL HEALTH AND ADDICTION SERVICES INTOXICATED DRIVING PROGRAM P.O. BOX 365 TRENTON, NJ 08625-0365 ELIZABETH
SAHARA Petrochemicals Company. Part I
Document Title Vendor Registration Form In Kingdom Page Page 1 of 9 Vendor Registration Number Vendor Details Sahara Use Only Part I Vendor Name Vendor Address Telephone No.: Fax No.: E-Mail: General Sales
EMPLOYMENT APPLICATION
DATE: EMPLOYMENT APPLICATION CITY OF SPRING GROVE 118 1 ST AVENUE NW PO BOX 218 SPRING GROVE, MINNESOTA 55974 (507) 498-5221 Title of job applied for: (Type or print) Last Name First Name MI Home Phone
General Radiology Improvement Database
The American College of Radiology General Radiology Improvement Database ABR PQI Project Description February 22, 2013 American College of Radiology 1891 Preston White Drive Reston, VA 20191-4397 Copyright
BANK REFERENCE LETTER/SOLVENCY CERTIFICATE (On Bank s Letter Head) Certified that M/s at (address) is having an account in our bank
Annexure -I BANK REFERENCE LETTER/SOLVENCY CERTIFICATE (On Bank s Letter Head) Certified that M/s at (address) is having an account in our bank as per following particulars:- 1. Type of Account : Cash-Credit/Current/Savings
WHITEHALL TOWNSHIP BUREAU OF PLANNING, ZONING & DEVELOPMENT POSITION DESCRIPTION. TITLE: Internship Pay Grade: $8.00/hour
WHITEHALL TOWNSHIP BUREAU OF PLANNING, ZONING & DEVELOPMENT POSITION DESCRIPTION TITLE: Internship Pay Grade: $8.00/hour GENERAL PURPOSE Performs a variety of routine work in general codes enforcement
CLASS III MEDICAL DEVICE LICENCE AMENDMENT APPLICATION FORM (disponible en français)
1. NAME(S) OF DEVICE LICENCE(S) BEIN AMENDED 2. LICENCE NUMBER(S) TO BE AMENDED: (provide the latest valid licence number(s)) 3. MANUFACTURER INFORMATION (as it appears on the label) Contact Name and Title:
Servicios De Control e Inspeccion S.A. NonDestructive Testing
This certificate is granted and awarded by the authority of the Nadcap Management Council to: Servicios De Control e Inspeccion S.A. Ctra. Ajalvir-Torrejon Km.1.8 Ajalvir Madrid, 28864 Spain This certificate
City of Kingsland, Georgia APPLICATION FOR EMPLOYMENT
Applicant Name: Position Applied For: Social Security Number: ***-**- City of Kingsland, Georgia APPLICATION FOR EMPLOYMENT IMPORTANT Employment At-Will If you are offered and accept employment with the
POSITION INFORMATION FORM FOR ALL CLASSIFIED & CERTIFICATED POSITIONS
C O N F I D E N T I A L LOS ANGELES UNIFIED SCHOOL DISTRICT POSITION INFORMATION FORM FOR ALL CLASSIFIED & CERTIFICATED POSITIONS PURPOSE: This form is for documenting the duties and responsibilities assigned
Supplier Capability Assessment
SUPPLIER CAPABILITY ASSESSMENT General Details Factory Name Factory and Audit Location Yiwu RedCherry Jewelry Co Ltd Building #4, No. 755, Xuefeng West Road, Yiwu City, Zhejiang Province, China Audit date
The transition to OptumRx is designed to help us better serve your employees and help improve their overall experience:
September 27, 2013 RE: Pharmacy Benefit Transition Plan for Oxford Clients Dear Valued Oxford Client, We are pleased to confirm that, effective Oct. 1, 2013, your pharmacy benefit services are being administered
Inspections, Compliance, Enforcement, and Criminal Investigations
Page 1 of 7 Inspections, Compliance, Enforcement, and Criminal Investigations Hammill Manufacturing Company 1/06/09 Department of Health and Human Services Public Health Service Food and Drug Administration
Secondary Department(s): Quality Management Health Plan Date Procedure Last Reviewed: December 28, 2011
Subject: Member Grievance and Grievance Appeal - MLTC- NY Primary Department: Managed Long Term Care Health Plan Effective Date of Procedure: December 1, 2005 Secondary Department(s): Quality Management
WARNING LETTER AUG 3, 2016
Ropack, Inc. 8/3/16 Department of Health and Human Services Public Health Service Food and Drug Administration 10903 New Hampshire Avenue White Oak Building 66 Silver Spring, MD 20993 WARNING LETTER AUG
DRIVER'S APPLICATION FOR EMPLOYMENT
DRIVER'S APPLICATION FOR EMPLOYMENT (Please Answer all Questions - Please Print) In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions
DRIVER APPLICATION
---------------------------------------------- DRIVER APPLICATION ------------------------------------------ MAILING: PO BOX 96 FIREBAUGH, CA 93622 PHYSICAL: 1487 13 TH STREET FIREBAUGH, CA 93622 PHONE:
Quality Control Review of the County of San Luis Obispo Internal Audit Division
Quality Control Review of the County of San Luis Obispo Internal Audit Division Conducted in accordance with guidelines of the Association of Local Government Auditors for the period July 1, 2011 through
Dear Company Representative,
Dear Company Representative, Thank you for your interest in our random drug screen consortium. Whether you are in a Consortium to meet Federal Regulations or for the Drug Free Workplace Program we can
Thank you for your interest in joining our team! Please take a moment to review the application checklist below before completing your application.
Thank you for your interest in joining our team! Please take a moment to review the application checklist below before completing your application. Only qualified applicants, who submit all requested information,
RADIOACTIVE MATERIALS REGULATORY GUIDE
RADIOACTIVE MATERIALS REGULATORY GUIDE MICROSPHERE BRACHYTHERAPY SOURCES AND DEVICES Radioactive Materials Unit 625 Robert Street North PO Box 64975 St. Paul, Minnesota 55164-0975 February 13, 2009 TABLE
CLASSIFIED APPLICATION PROCEDURES PLEASE READ THIS SHEET BEFORE FILLING OUT THE APPLICATION MATERIALS
1171 Whitlock Ave. Marietta, Georgia 30064 CLASSIFIED APPLICATION PROCEDURES Phone: (770) 429-3170 Fax: (770) 429-3178 Web Site: www.mariettacommunityschool.com E-Mail: kchappell@marietta-city.k12.ga.us
RIS / PACS A WEB-BASED APPLICATION DESIGNED TO AUTOMATE YOUR WORKFLOW
RIS / PACS A WEB-BASED APPLICATION DESIGNED TO AUTOMATE YOUR WORKFLOW About us Our Company Our Mission is Simple Our company is Canadian and was established in 1994. After over 20 years, we continue to
REQUEST FOR SPECIAL IDENTIFICATION NUMBER (MVIN) APPLICATION CHECKLIST
STATE OF INDIANA Michael R. Pence, Governor R. Scott Waddell, Commissioner REQUEST FOR SPECIAL IDENTIFICATION NUMBER (MVIN) APPLICATION CHECKLIST Special Identification Number applications for a vehicle
Selenia Digital Breast Imaging Saving Time, Saving Lives.
B R E A S T I M A G I N G S O L U T I O N S Selenia Digital Breast Imaging Saving Time, Saving Lives. Saving Time, Saving Lives... Selenia reveals life-saving details, improves workflow, and gives you
APPENDIX B INSTRUCTIONS AND SAMPLE APPLICATION FORMS FOR AUTHORIZATION
75 APPENDIX B INSTRUCTIONS AND SAMPLE APPLICATION FORMS FOR AUTHORIZATION PAGE INSTRUCTIONS FOR COMPLETING AN APPLICATION FOR THE HUMAN USE OF RADIOACTIVE MATERIALS 76-77 SAMPLE APPLICATION FOR HUMAN USE
STATE OF IOWA. Water Quality
Fields of Opportunities THOMAS J. VILSACK GOVERNOR SALLY J. PEDERSON LT. GOVERNOR STATE OF IOWA DEPARTMENT OF PUBLIC HEALTH MARY MINCER HANSEN, RN, PhD DIRECTOR Iowa Department of Public Health, in conjunction
Supplier Registration Form Delaware and Maryland. Please send the completed executed form along with your remaining registration documents to:
Supplier Registration Form Delaware and Maryland Please send the completed executed form along with your remaining registration documents to: Delmarva Power and Light Supplier Relations 701 Ninth St N.W.,
Inspections, Compliance, Enforcement, and Criminal Investigations
Inspections, Compliance, Enforcement, and Criminal Investigations Gazda, Thomas M.D. 11/24/09 Department of Health and Human Services Public Health Service Food and Drug Administration Silver Spring, MD
IBERIA LINEAS AEREAS DE ESPAÑA SOCIEDAD ANONIMA OPERADORA Dirección Técnica. NonDestructive Testing
This certificate is granted and awarded by the authority of the Nadcap Management Council to: IBERIA LINEAS AEREAS DE ESPAÑA SOCIEDAD ANONIMA OPERADORA Dirección Técnica A/ Sede central, Aeropuerto de
Justification for Training
This educational program is being offered to provide training to medical practitioners who perform or supervise the performance of diagnostic procedures utilizing fluoroscopic x- ray units. There are many
PUBLIC RECORD. Record of Determinations Medical Practitioners Tribunal. Date: 05/09/2017. Medical practitioner s name: Dr Pawel MIKLASZEWICZ
PUBLIC RECORD Date: 05/09/2017 Medical practitioner s name: Dr Pawel MIKLASZEWICZ GMC reference number: 6121969 Primary medical qualification: Type of case Review - Non-compliance with a performance assessment
Recognized Experts. Competence Area
1(4) Recognized Experts Competence Area This memo concerns the content of detailed instructions for the evaluation and approval of recognized experts in accordance with section 48, subsection 2 of the
Person in charge (PIC) Person participating in management (PPIM)
Health Information and Quality Authority Personal Information m * Section 1. Designated centre details. Centre name Centre ID (OSV) Section 2. Contact details for the person. Please tick the relevant role
3. VERIFICATION OF ITEMS SUBMITTED: All documentation submitted will be verified.
Name of Applicant (please print) Date of Application INSTRUCTIONS FOR COMPLETING APPLICATION 1. APPLICATION APPROVAL: Please allow four to eight weeks for processing your application from the date of receipt
14. EDUCATION AND TRAINING CHECK HIGHEST GRADE COMPLETED GRADE SCHOOL HIGH SCHOOL COLLEGE GRADUATE SCHOOL
APPLICATION FOR EMPLOYMENT City of Salisbury Human Resources Department 125 N. Division St., Salisbury, MD 21801 410-548-1065 Fax: 410-548-3748 website: www.ci.salisbury.md.us email: jobs@ci.salisbury.md.us
Maryland Department of the Environment
Maryland Department of the Environment APPLICATION FOR RADIOACTIVE MATERIAL LICENSE AUTHORIZING THE USE OF SEALED SOURCES IN XRF DEVICES Maryland Department of Environment (MDE) is requesting disclosure
Central Florida Large Animal Veterinary Services
Central Florida Large Animal Veterinary Services PO Box 701837 Saint Cloud, FL 34770-1837 407-892-2034 ***Please submit full application with resume and cover letter stating qualifications for the job.***
Guidance for Sponsors, Institutional Review Boards, Clinical Investigators and FDA Staff
Guidance for Sponsors, Institutional Review Boards, Clinical Investigators and FDA Staff Guidance on Informed Consent for In Vitro Diagnostic Device Studies Using Leftover Human Specimens that are Not
NOTICE OF JOB OPENING. CUSTOMER SERVICE REPRESENTATIVE-OFFICE (2 Part-Time Positions Available)
NOTICE OF JOB OPENING CUSTOMER SERVICE REPRESENTATIVE-OFFICE (2 Part-Time Positions Available) Opening Date: February 10, 2015 Classification: Grade 5 Non-Exempt ($17.65 per hour-entry) Closing Date: February