CPD LOG FOR RECERTIFICATION ACTIVITIES

DURING A THREE-YEAR PERIOD

Dean T Lloyd
Full Name: ______________________________________________________________________
70814277
NICET ID or Certification Number: ____________
3 14
Expiration Date (month/year): _____/_____
CPD points must be accumulated during the three years previous to your expiration date.
Transportation Engineering Technolgy / Highway Construction
Field/Subfield Name (from section 2 of Recertification Invoice): ________________________________
Keep a separate log for each certification you wish to recertify. This will help minimize over and under counting CPD points.

Carefully read Policy #30, “Continuing Professional Development” and its Exhibit I before beginning to fill out your log.

INSTRUCTIONS
NICET encourages and requires professional development through recertification. NICET-certified engineering
technicians and technologists, at the end of a three year period are required to demonstrate professional growth via
90 continuing professional development (CPD) points. Using a pre-established point scale, candidates may earn
points serving as an active practitioner, additional education, certification activity, participation in advancing your
profession, or a special exam.

Your CPD log is required with submission of your Recertification Invoice and payment.

SECTION A: ACTIVE PRACTITIONER

Most of your accumulated points will come from Section A, “Active Practitioner”.
 Complete in chronological order, accounting all relevant engineering technician or related work experience
within your three-year recertification period. You are encouraged to use a separate page for each
(different) employer. Photocopy extra copies of Section A, as needed.
 Any job title or responsibility change occurring with the same employer should be listed separately on the
same page. Include only details of activities pertinent to the certification you wish to recertify.
 Count conservatively the hours associated with each certification area. This will help you in determining if
other activities are necessary for recertification.
 Persons with multiple certifications that are minimally related need only average 2 hours per day to meet
the minimum of 500 hours per year to earn 12 points per year as an active practitioner.
SECTION B: ADDITIONAL EDUCATION
 List all relevant college courses, workshops, seminars, and technical presentations at meetings and training
sessions—by type—you attended WITHIN YOUR THREE-YEAR RECERTIFICATION PERIOD.
You may also count company monthly training sessions if the training is new material.
 Retain course announcements, certificates of accomplishment, etc. as evidence of participation.
SECTION C: ADVANCED PROFESSION
 List all relevant activities—by type—you participated in WITHIN YOUR THREE-YEAR
RECERTIFICATION PERIOD.
 Retain invitations to participate, letters of appreciation, etc. as evidence of participation.
SECTION D: CERTIFICATION ACTIVITY
 List all relevant NICET testing/certification as well as all relevant Non-NICET certification activity you
participated in WITHIN YOUR THREE-YEAR RECERTIFICATION PERIOD.
 Testing/certification activities with incomplete results may be listed – but CPD points cannot be assigned
until results are finalized and/or higher levels of certifications awarded.
SECTION E: SPECIAL EXAM
 A Special Exam is not necessary for recertification unless you wish to maintain a certification area in which
you are no longer an active practitioner or you need additional CPD points for recertification.

1420 King Street, Alexandria, VA 22314-2794 888-476-4238 +1-703-548-1518 703-682-2756 fax

 Dean T Lloyd
Full Name: ______________________________
70814277
NICET ID or Certification Number: _____________

ADDITIONAL INFORMATION:
 Avoid dual counting of hours/activities whenever possible – particularly when you are recertifying in more
than one certification area.
 We use the same criteria for counting work activities as pertinent to a particular field/subfield as we do for
initial or upgraded certification.
 NICET will perform a random audit on a percentage of certificants who submit recertification documents
prior to the expiration date. If your application undergoes an audit, you are required to submit
documentation for the points you claimed. NOTE: Individuals with multiple certifications have a higher
probability of undergoing an audit than those with a single certification. You should keep this log, a copy
of Policy #30, and all supporting documentation in a single, convenient, and secure location.
 You must sign and date your log.
 You may submit this log electronically to [email protected]. For the purpose of electronic processing, an
electronic signature constitutes the same as a handwritten signature. By submitting this form electronically,
you are agreeing that you have read and understood all instructions and accept conditions set forth within.

1420 King Street, Alexandria, VA 22314-2794 888-476-4238 +1-703-548-1518 703-682-2756 fax

 Dean T Lloyd
Full Name: ______________________________
70814277
NICET ID or Certification Number: _____________

SECTION A. ACTIVE PRACTITIONER (Exhibit I, Paragraph II.A.)

NOTE: It is recommended that you list only one employer per page. You may make additional copies of this form as
needed.

List in the column below:

Dates of Employment
(during CPD period) a) Name & address of employer;
b) Your title(s);
From To c) Name & title of your immediate supervisor;
(Mo/Yr) (Mo/Yr) d) Description of your duties and job responsibilities; and
e) CPD points for each position you have held.
CPD
Points

Total Active Practitioner Points

1420 King Street, Alexandria, VA 22314-2794 888-476-4238 +1-703-548-1518 703-682-2756 fax

Full Name: ______________________________
Dean T Lloyd NICET ID or Certification Number: _____________
70814277

SECTION B. ADDITIONAL EDUCATION (Exhibit I, Paragraph II.B.)

COLLEGE CREDIT COURSES RELATED TO CERTIFICATION AREA

Date(s)
Attended No. of Hrs Earned
_______ /______ CPD
Name of School Course Title/Description From To Semester Quarter Points

OFFERINGS WITH PREASSIGNED CEU’s RELATED TO CERTIFICATION AREA

(if issued a certificate of completion and the CEU’s are listed on that document, then calculate your points
here)
Date(s)
Attended CPD
Name of Sponsor Course Title and Description From To Number CEUs Points

OTHER OFFERINGS (FORMAL/INFORMAL) RELATED TO CERTIFICATION AREA

(if no CEU’s were assigned, list your training here, one point for every hour of training)
Date(s)
Attended Number of Contact CPD
Name of Sponsor Title and Description From To Hours Points
OSHA 10 Hour Outreach Training Program - Construction 7/12/15 7/13/15 10.0 10

1420 King Street, Alexandria, VA 22314-2794 888-476-4238 +1-703-548-1518 703-682-2756 fax

 Dean T Lloyd
Full Name: ______________________________
70814277
NICET ID or Certification Number: _____________

SECTON C. ADVANCED PROFESSION (Exhibit I, Paragraph II.C.)

ACTIVE COMMITTEE/TASK FORCE SERVICE RELATED TO CERTIFICATION AREA

Type of Committee/ Dates of
Task Force Service

Name of Name of Committee/ (National, Regional, Title CPD

Organization Task Force State, Local) Position From To Points

PRESENTATIONS RELATED TO CERTIFICATION AREA

Name of Type of CPD

Sponsor Presentation Title/Description Role Date(s) Points

COURSE INSTRUCTION RELATED TO CERTIFICATION AREA

Contact Dates
Hrs./Semester CPD
Name of Sponsor Course Title/Description Hrs./Quarter Hrs. From To Points

CAREER DAY PRESENTER RELATED TO CERTIFICATION AREA

Name of CPD
Sponsor Event Title Location Student Level Date Points

PROFESSIONAL SOCIETY ACTIVITY RELATED TO CERTIFICATION AREA

CPD
Name of Organization Type of Participation Date(s) of Service/Attendance Points

1420 King Street, Alexandria, VA 22314-2794 888-476-4238 +1-703-548-1518 703-682-2756 fax

 Dean T Lloyd
Full Name: ______________________________
70814277
NICET ID or Certification Number: _____________

SECTION D. CERTIFICATION ACTIVITY (Exhibit I, Paragraph II.D.)

NICET CERTIFICATION ACTIVITY (I.E. UPGRADE, INITIAL CERTIFICATION RELATED AREA)

Work Element Format
Standard Model Format
(Enter Passed Elements/Exam Req.
(Select only one.)
Met OR Awarded)

Passed Exam CPD Exam Req. CPD

Date Elements Req. Met Awarded Points Date Met Awarded Points

NON-NICET CERTIFICATION ACTIVITY IN A RELATED PRACTICE AREA

Name of Provider Certification Title/Level Date Awarded CPD Points

SECTION E. SPECIAL EXAM

CPD points may be claimed only if a passing score is achieved on the special exam.

Date of Exam: CPD Points:

SIGN AND DATE (REQUIRED)

I certify that the information submitted in this application package is correct, factual and complete. I understand that any
misrepresentation of information can result in the rejection of this application and the revocation of any/all NICET certifications
issued in my name. I further certify that I have read and I understand the NICET Continuing Professional Development policy; I
accept the conditions set forth; and I have accurately stated my wishes and all CPD points in accordance with NICET’s Policy #30
(Continuing Professional Development). I understand that the payment is nonrefundable and that I may be asked to submit
documentation supporting my CPD points as a requirement for recertification.
By submitting this form electronically, you are agreeing that you have read and understood all instructions and accept conditions set
forth within. Individuals who are mailing the form must sign and date below. For the purpose of electronic processing, an electronic
signature constitutes the same as a handwritten signature.

Signature: ______________________________________________________ Date: ______________________________

1420 King Street, Alexandria, VA 22314-2794 888-476-4238 +1-703-548-1518 703-682-2756 fax