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DOE-HDBK-1130-98
Module 10.1: Sample Checklist
Attachment 2
ATTACHMENT 2 - Sample Grading Checklist for RW II
TRAINING COMPLETION RECORD
Name
SSN/EMPLOYEE#
COMPANY
Item Evaluated
Pt Val
Score
total 20 pts.
Pre-Job Preparation
Selected proper PCs.
5
Selected and properly wear dosimetry.
5
**
Donned PCs properly.
5
Recorded appropriate information.
5
Knowledge Level (See Attachment 5)
total 20 pts.
Enter results of knowledge-level evaluation.
20
Radiological Work Practices
total 20 pts.
**
Minimized exposure while completing task.
4
Minimized Radioactive Waste.
4
Didn't walk thru contamination unnecessarily.
4
Didn't spread contamination.
4
Chose low exposure route.
4
total 20 pts.
Emergency Response
**
Responded to alarm.
10
Exited area.
5
Notified RCT upon exit.
5
Exit Practices
total 20 pts.
Followed undress procedure.
**
3
Did not contaminate step-off pad.
3
Did not contaminate self.
**
7
**
Performed whole body survey properly.
5
Surveyed DRD.
1
Read DRD correctly upon exit.
1
100 pts.
I was instructed on the proper performance of all items for which my performance was unsatisfactory. I had the opportunity to ask questions. I
understand that failure of this exercise restricts me from entering the following areas:
Student
Date
Instructor
Date
Note: Comments on reverse.
** Indicates significant mistake. If not identified by student, deduct 21 points.
129


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