Get Certificate For Associated Member S Of The Cern Personnel - Sicurezza Le Infn

This guide provides users with clear and concise instructions on filling out the CERTIFICATE for associated members of CERN personnel who are occupationally exposed to ionising radiation. Following these steps will ensure that the form is completed accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to access the CERTIFICATE and open it for editing.
2. Enter the CERN ID if available. If you do not have a CERN ID, skip this step.
3. Fill in the name and first name(s) exactly as they appear in the user's passport.
4. Input the date of birth using the format day/month/year.
5. Provide the name and address of the home institution where the associated member is employed.
6. Enter the name and email address of the person responsible for radiation protection at the home institution.
7. The authorized representative from the home institution must certify the employment and compliance with radiation exposure requirements. Ensure that this section is correctly filled out.
8. If applicable, state any different effective dose constraint and the corresponding period in the space provided.
9. Acknowledge CERN's responsibility for operational aspects of radiation protection by including any necessary statements.
10. Fill in the expiry date of the certificate in the appropriate section.
11. Ensure the date of signing is included.
12. Obtain the signature of the authorized representative and stamp from the institution.
13. Type the name of the signatory in block capitals as required.
14. Specify the function of the signatory in the provided field.
15. Once all sections are filled out, users can save the changes, download, print, or share the completed form.

Complete your documents online to ensure compliance and streamline your process.