Advanced Decon Training Registration

Advanced Decon Training Registration
To be considered for Advanced Decon Training, please complete the qualification survey. This class is for people who have existing decontamination experience in their respective programs and be WIT II graduates. Please complete the registration, and if needed, a recommendation letter from your supervisor that supports your qualifications for the class.
Name*

First NameLast Name
State/Agency*
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Tell us about your previous Inspection/Decontamination Training.
When did you receive inspection/decontamination training?*
Who conducted the training?*
Are you currently involved in an inspection/decontamination program?*

YesNo
How many inspections have you personally performed?*

What types of watercraft have you inspected, and how many inspections have you conducted by watercraft type?*

What level are you currently employed?*

Upper managementSupervisorInspectorDecontaminatorOther
How long have you been employed in your current position?*

1-3 years3-5 years5+ years
If you conduct in-house training, please check all that apply.

1-3 years3-5 years5+ years
Please check the appropriate box for the type of in-house training you provide:

InspectionsDecontaminations
How many decontaminations have you personally performed?*
Is your program mandatory?*

YesNo
Please check which best describes your program: *

Entrance inspection programExit inspection programInspection and decontamination program - entranceInspection and decontamination program - exit
Do you have a written manual?*

YesNo
If you have a written manual, please note whether it is for prevention and/or containment by checking the appropriate box.

PreventionContainmentBoth Prevention and Containmnet
Is there any other information you would like to share with us?
Please include a recommendation letter from your supervisor that expresses the skills/experience that you have indicated above.

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Contact information for "Quagga D" Davis:

(702) 236-3814

quaggadee@cox.net
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