| Trainee
Name____________________________ |
| Trainee
Social Security Number: ____________ |
| Trainee
Status: _______ |
| Course
Name: ___________________ |
| Course
Code: ___________________ |
| National
Center Course Number: ___________ |
| Date Course
Completed: ____________________ |
| Performance
Criteria Completed: _____________ |
| Performance Objectives: | ||
| Pass | Fail | |
| Topic 1: Types of Fasteners | ||
| 1.1
Identify examples of common types of threaded fasteners and describe applications for which these fasteners might be used. |
____ | ____ |
| 1.2
Identify examples of common types of non-threaded fasteners and describe applications for which these fasteners might be used. |
____ | ____ |
| Topic 2: Installing Fasteners | ||
| 2.1
Properly install various types of threaded fasteners including toggle bolts, anchor bolts, and expansion anchor bolts. |
____ | ____ |
| 2.2 Properly install a blind rivet. | ____ | ____ |
| Performance
Evaluator’s Signature:____________________________ |
| Performance
Evaluator’s Name (Print):____________________________ |
| Date
Completed:____________________________ |