NCCCO Written Exam Scheduled

ATTENTION
OPERATING ENGINEERS
NCCCO Written Exam Scheduled
For First Time Testers and Recertifications
Saturday, August 27, 2016
@ IUOE Local 181 Boston Training Site
1450 Wilson Creek Rd – Boston, KY 40107
Prep Sessions will be held at the Boston Training Site:
Friday & Saturday, August 19th & 20th
Additional Load Chart Instruction Friday, August 26th
Application deadline is Tuesday, August 9, 2016
Class size is limited
Call 502-833-2358 for an Application Packet or
Download from our website www.iuoelocal181.org
Testing for IUOE members only
International Union of Operating Engineers, Local 181
JOINT APPRENTICESHIP AND TRAINING PROGRAM
IUOE Local 181, Indiana Construction Association, Building Division - ICA, Inc.
And Highway Contractors, Inc.
From the Office of:
From the Office of:
■ Boston Training Site
P.O. Box 78
1450 Wilson Creek Rd.
Boston, KY 40107
Phone: 502-833-2358
Fax: 502-833-3224
□ Lynnville Training Site
722 E. S.R. 68
Lynnville, IN 47619
Phone: 812-922-5541
Fax:
812-922-5018
□ Master Records and Bookkeeping Office
P.O. Box 34 ● Henderson, KY 42419-0034
Phone: 270-826-2704 ● Fax: 270-827-2014
All forms were revised in June 2016. Previous revisions will not be accepted by NCCCO. If you need the new forms please
call us or access the new forms on the Internet at www.nccco.org and click on Handbooks & Forms or at Local 181’s
website www.iuoelocal181.org click on Apprenticeship & Training, see NCCCO Testing Information.
Mail Completed Applications to:
IUOE Local 181 JATC
PO Box 78
Boston KY 40107
Checks / Money Orders are to be made payable to: NCCCO

Lodging – If mileage from your home to the training site (one way) is over One Hundred (100) miles, you qualify for a motel room.
General Nelson Inn in Bardstown or Days Inn in Elizabethtown – Please submit the enclosed NCCCO Prep Session &
Motel Reservation Questionnaire with your completed Application. (To make changes to your reservation call the
Boston Training Site 502-833-2358 during Business hours 7:00 a.m. to 3:30 p.m. EST)
PLEASE NOTE THAT THE TRAINING PROGRAM “REIMBURSEMENT POLICY” HAS BEEN AMENDED AS FOLLOWS:
If the member has asked for a room reservation that he/she cannot fulfill, he/she must call the motel to cancel the reservation. If the
reservation is not cancelled and the Program is billed for the “no show”, the hotel charges will be deducted from future
reimbursements due to the member.
The test is scheduled as follows:

Application Deadline
Completed Applications & Exam Fees due in Boston by Noon on Tuesday, August 9, 2016.

Prep Classes – Boston Training Site
Friday and Saturday, August 19th & 20th starting at 7:00 a.m. Eastern Standard Time
*Please note that the following 4 load charts only will be covered during the Prep Session: Manitowoc (for Lattice Boom
Crawler and Truck), Grove (Large Telescopic-Swing Cab), and Shuttlelift (Small Telescopic-Fixed Cab)
*Additional Load Chart Instruction will be available Friday, August 26th

Written Test – Boston Training Site
Saturday, August 27, 2016 at 8:00 a.m. EST – Site will be open for members by 7:00 a.m. EST

Test Site # - KY21736

Recertification applications must include a color photo without hat/sunglasses and a copy of your
current NCCCO certification card. The training site may have a useable photo on file, please call ahead
to verify.
Applicants adding specialties must include a copy of your current NCCCO certification card.
All applications must include payment.


Per IAI: Candidates will be charged an additional $30 fee if: your application form is incomplete; you do not send in full
payment, you do not select a load chart option on specialty exam; or if you change load chart options after packet is sent in;
or if you decide to add a specialty after packet is sent in; or if your check or credit card charges are declined. There is a $50
late fee for applications sent in after the application deadline and the late fee must be included with the application.
CCO Reminders
Please Read & Follow all enclosed Directions
Completed Applications and exam fees are to be returned to the Local 181 training site hosting the test.
Please Print Legibly
More information about the National Commission for the Certification of Crane Operators (NCCCO) is available
online at http://nccco.org
Candidate Handbooks and other forms are also available at http://nccco.org
Make sure that you are familiar with all of NCCCO’s policies and procedures.
Seat Time Required:
The JATC Board approved the following August 14, 2009:
A candidate must have at least 1000 hours of documented seat time in the past four years before applying for the
Practical (hands on) Examination. As of February 11, 2011 seat time acquired at either Local 181 training site, at
the discretion of the site manager, can count towards the 1000 hour requirement.
Physical Examinations:
Certified crane operators must continue to meet ASME B30 physical requirements throughout certification and
you attest that you are in agreement with this requirement when you sign your application. Means of compliance
with ASME physical requirements include, but are not limited to, the following:
 NCCCO Physical Examination form – valid for three years
 A current Department of Transportation (DOT) Medical Examiner’s Certificate – valid for two years
To Receive Reimbursement - You Must Submit a Copy of Your NCCCO certification card*:
Please be advised that the JATC Board revised the NCCCO Reimbursement Policy May 23, 2011 as follows:
Reimbursement will be processed when the training site has received notification that a passing grade has been
awarded for both the written and practical exams and the member has provided a copy of their NCCCO
certification card to the training site. *Only Local 181 Members in good standing are eligible for reimbursement.
Tower Crane / Overhead Crane Notice:
Written exams for the Tower Crane and Overhead Crane can be taken at either training site at a regularly
scheduled NCCCO Written Exam however, please be advised that neither Local 181 Training Site is able to give the
Practical Exam for these 2 specialties at this time. You will need to make arrangements with another Local to take
the Practical Exam for the Tower and Overhead Cranes. The chosen test site must be approved by a Local 181
Training Site Manager.
To receive reimbursement for your Tower / Overhead Crane Exam you will need to provide the training site with
written documentation of a passing grade received for both the written and practical tests and a copy of your
NCCCO certification card. Members may also be eligible for mileage and motel reimbursement to and from the
practical exam test site. *Only Local 181 Members in good standing are eligible for reimbursement.
Prep Session Topics:
Day 1 – Standards and Core Questions
Day 2 – Load Charts
The following Load Charts ONLY will be covered during the Prep Session:
Manitowoc – (LBC) Lattice Boom Crawler
Manitowoc – (LBT) Lattice Boom Truck
Grove (Truck Mount) – (TLL) (Large) Telescopic Boom - Swing Cab
**NEW** Shuttlelift (Carry Deck) – (TSS) (Small) Telescopic Boom - Fixed Cab **NEW**
Anyone interested in load charts for any other cranes will need to call the Training Site at 502-833-2358 to
schedule training.
Please return completed applications with requested documents by August 9, 2016 to:
IUOE Local 181 JATC
PO Box 78
Boston KY 40107
Applications received after the application deadline are subject to a $50 late fee which
must be included with the application
APPLICATION CHECKLIST
All Candidates:
□ Prep Session & Motel Reservation Questionnaire
First Time & Retest Applicants:
□ Completed and Signed Application Revised 06/16*
□ Load Charts Selected
□ Payment (Made Payable to: NCCCO) No Cash Accepted
□ Signed Hold Harmless Agreement
□ Completed Experience Form
Applicants Adding Specialties:
All items listed above plus □ Copy of current NCCCO Certification Card
Recertification Applicants and Lift Director Applicants:
□ Completed and Signed Application Revised 06/16*
□ Load Charts Selected
□ Color Photo – full face, no sunglasses, no hat
The Training Site may have a useable photo on file, please call ahead to verify
A digital photo may be emailed to [email protected]
□ Copy of current NCCCO Certification Card
□ Payment (Made Payable to: NCCCO) No Cash Accepted
□ Signed Hold Harmless Agreement
*All application forms were revised June 2016.
Previous revisions will not be accepted by NCCCO.
□ Copy of your IUOE Registration Card if you are a member of another local.
You will also need to provide a letter from your home office stating that you are a member
in good standing with the Local.
NCCCO Prep Session & Motel Reservation Questionnaire
NCCCO Test August 27, 2016
Print Name:
Please check all that apply
□ I will not attend any NCCCO Prep Sessions
□ I will attend the NCCCO Prep Sessions
□ *Friday, August 19th only
(Core Exam Questions)
□ **Friday and Saturday, August 19th & 20th
□ ***Saturday, August 20th only
(Load Chart Instruction)
□ ****Additional Load Chart Instruction Friday, August 26th
□ I do not live 100 miles (one way) from the training site and do not qualify for a motel room
□ I am a member of another Local and do not qualify for a motel room
□ I live 100 miles (one way) from the training site and will need a motel room
CHOICE - I prefer to stay at the (Please Circle One):
General Nelson Inn in Bardstown
Days Inn in Elizabethtown
For the Prep Session:
□ *Arriving Thursday, August 18th – Check Out Friday, August 19th
□ **Arriving Thursday, August 18th – Check Out Saturday, August 20th
□ ***Arriving Friday, August 19th – Check Out Saturday, August 20th
For the Test & Additional Load Chart Instruction (Friday before the test):
□ ****Arriving Thursday, August 25th – Check Out Saturday, August 27th
□ Arriving Friday, August 26th – Check Out Saturday, August 27th (Test only)
□ Special Instructions (i.e. you qualify for a motel room but plan to drive):____________________________
___________________________________________________________
Notes: Only Local 181 members are eligible for motel rooms paid for by the training fund
Reservations must be made by Training Site Personnel
PLEASE NOTIFY THE TRAINING SITE OF ANY CHANGES TO YOUR RESERVATIONS
PLEASE NOTE THAT THE TRAINING PROGRAM “REIMBURSEMENT POLICY” HAS BEEN AMENDED AS FOLLOWS: If the member has asked for a
room reservation that he/she cannot fulfill, he/she must call the motel to cancel the reservation. If the reservation is not cancelled and the
Program is billed for the “no show”, the hotel charges will be deducted from future reimbursements due to the member.
To Cancel Your Reservation Call: Boston Training Site 502-833-2358 during business hours Mon-Fri
7:00am – 3:30pm EST - After Hours Call: General Nelson Inn 502-348-3977 / Days Inn 270-769-5522
AND call the Training Site ASAP and notify us of any changes!
Operating Engineers Local 181
Apprenticeship and Training Program
NCCCO CRANE CERTIFICATION
WAIVER AND HOLD HARMLESS AND INDEMNIFICATION AGREEMENT
The undersigned enters into this Waiver and Hold Harmless and Indemnification
Agreement based upon the following Agreement:
The undersigned person, hereby waives any right he/she may have to take any action
against the I.U.O.E. Local 181 and the Joint Apprenticeship and Training Programs of the
I.U.O.E., Local 181 as a result of the information release described below, and the undersigned
person hereby agrees to indemnify and hold harmless the I.U.O.E., Local 181 and the Joint
Apprenticeship and Training Programs of the I.U.O.E., Local 181, in Indiana and Kentucky, their
Agents, Representatives and Trustees against any and all claims or demands or causes of action
made by anyone, including the undersigned, growing out of or in any manner attributable to any
injuries or damages that may be sustained or incurred by said person or anyone on his behalf
arising from injuries incurred from any employment or activity resulting from said release of
information which may arise in the future and any expenses incurred by I.U.O.E., Local 181 and
the Joint Apprenticeship and Training Programs of the I.U.O.E., Local 181 in defending any such
action brought by any person whatsoever, whether such claim or action arises direct, by
subrogation, assignment or otherwise.
I hereby acknowledge that no promise, inducement or agreement not herein
expressed has been made to me and that this Hold Harmless Agreement contains the entire
Agreement between the parties hereto and that this Agreement is contractual and not a mere
recital.
The undersigned has read the foregoing Agreement of Indemnification and fully
understands it.
I,
herein grant permission to the I.U.O.E. Joint
Apprenticeship and Training Program to release my CCO Crane Certification Test Scores and
information pertaining to my CCO Crane Certification.
Dated this
day of
, 2016
.
(Signature)
LOCAL 181 OPERATING ENGINEERS EXPERIENCE FORM FOR CCO TESTING Operators Name ___________________________________________________________________________________________________ Address: _________________________________________________________________________________________________________ SS #: ________________________________ Date of Birth: ____________________________________ A candidate must have had at least 1000 hours of documented experience in the past four years before applying for the Practical (hands on) Examination.1 For practical examination purposes, experience is defined as any crane or hoisting operating experience. On this basis, please list below the employment dates, employing company or organization and specific job responsibilities applicable to the experience gained in crane operation. NOTE: Photocopy this page to document additional positions held. Please make sure you enclose the Experience form with your completed application. DO NOT STAPLE form to your application. I. Company/Organization: ____________________________________________________________________________________________ Address: _________________________________________________________________________________________________ Job Title: ________________________________________Dates: From_______________________ To _____________________ Supervisor: __________________________________ Title: _______________________ Phone: ( ) ______________________ Describe your specific job responsibilities and experience: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Approximate number of hours of crane operation: __________________ II.Company/Organization: ____________________________________________________________________________________________ Address: _________________________________________________________________________________________________ Job Title: ________________________________________Dates: From_______________________ To _____________________ Supervisor: __________________________________ Title: _______________________ Phone: ( ) ______________________ Describe your specific job responsibilities and experience: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Approximate number of hours of crane operation: __________________ The attestation statement below must be signed by the candidate. I hereby attest that the information provided above is accurate, complete and truthful, and that I have accomplished the required experience in crane operation. I understand that it is the policy of IUOE to conduct random audits of applications and that falsification of any information in the application may result in denial to take the certification examination and and/or revocation of certification. Signature: __________________________________________________ Date: ______________________________________ 1
Individuals whose crane operating experience did not occur within the past four years, and who have more than 1000 hours of experience may petition the Local 181 Certification Committee to sit for the examination. Call 812‐922‐5541 or 502‐833‐2358. Candidate Application
WRITTEN EXAMINATION—MOBILE, TOWER, & OVERHEAD
CRANE OPERATOR (PAPER/PENCIL TESTS ONLY)
Please type or print neatly.
FULL LEGAL NAME
(as shown on driver’s license)
First
Middle
CCO CERTIFICATION NUMBER (if previously certified)
Last
DATE OF BIRTH
Suffix (Jr., Sr., III)
SOCIAL
SECURITY #
CITY
MAILING ADDRESS
PHONE
CELL
COMPANY/ORGANIZATION
FAX
IUOE Local 181
COMPANY MAILING ADDRESS
STATE
E-MAIL
PHONE
CITY
PO Box 34
ZIP
270-826-2704
STATE
Henderson
KY
ZIP
42419
 I AM REQUESTING TESTING ACCOMMODATIONS IN COMPLIANCE WITH THE AMERICAN WITH DISABILITIES ACT (ADA).
(For details on NCCCO’s Testing Accommodations policy, please see www.nccco.org/accommodations.)
WRITTEN EXAMINATION(S) FOR WHICH YOU ARE APPLYING
FILL IN the circle next to the crane type(s) for which you are applying; for Mobile Cranes, CHECK ☑ the load chart you want to
use for that crane type. Also FILL IN the appropriate circle(s) below for correct fees. NOTE: If you are registering for Mobile Crane
exams, you must register for the Mobile Core Exam and at least one Specialty Exam (unless you are a Retest Candidate).
If you are recertifying, please use separate Recertification Written Examination Application Form.
WRITTEN EXAMS
LOAD CHARTS
PP Mobile Core Exam
652603
(Check one for each Specialty Exam)
PP Lattice Boom Crawler 652620 Terex/American
(LBC)652607
Manitowoc
PP Lattice Boom Truck
(LBT)
652609 Link-Belt
652610
Manitowoc
PP Telescopic Boom— 652612  Grove (Truck Mount)
Swing Cab (TLL)
652613  Link-Belt (Rough Terrain)
PP Telescopic Boom— 652616  Manitex (Boom Truck)
Fixed Cab (TSS)
652660  Shuttlelift (Carry Deck)
PP Boom Truck—Fixed 652671  Manitex (Boom Truck)
Cab (BTF)
PP Tower Crane
654601
PP Overhead Crane
653601
OTHER FEES
WRITTEN EXAM/RETEST FEES
MOBILE CRANE EXAMS
PP Core Exam plus one Specialty Exam............................... $165
PP Core Exam plus two Specialty Exams.............................. $175
PP Core Exam plus three Specialty Exams............................ $185
PP Core Exam plus four Specialty Exams............................. $195
RETEST or ADDED SPECIALTY FEES
PP Core Exam only or Core plus one Specialty (Retest)......... $165
PP One Specialty Exam (Retest or Added Specialty)................ $65
PP Two Specialty Exams (Retest or Added Specialty).............. $75
PP Three Specialty Exams (Retest or Added Specialty)............ $85
PP Four Specialty Exams (Retest)........................................... $95
TOWER CRANE EXAMS
PP Tower Crane Written Exam (new Candidate)................... $165
PP Tower Crane Written Exam (current CCO-certified
Mobile Crane Operator, or new candidate taking
exam same time as Mobile Crane exams)......................... $50
OVERHEAD CRANE EXAMS
PP Candidate Late Fee (if applicable).................................... $50
PP Incomplete Application Fee (if applicable)......................... $30
PP Updated/Replacement Card............................................. $25
PP Overhead Crane Written Exam (new Candidate)............. $165
PP Overhead Crane Written Exam (current CCO certified Mobile Crane Operator, or new candidate
taking exam same time as Mobile Crane exams).............. $50
ADD TO TOTAL AMOUNT AT RIGHT
TOTAL AMOUNT DUE . . . . . . . . . . . $
Copyright 1996–2016 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 06/16
27
CANDIDATE APPLICATION (CONT’D)
WRITTEN EXAMINATION—MOBILE, TOWER, & OVERHEAD CRANE
OPERATOR
TEST SITE AT WHICH YOU INTEND TO TAKE THE WRITTEN EXAMINATION
TEST SITE NAME
TEST SITE ADDRESS
CITY
TEST SITE COORDINATOR
IUOE Local 181 JATC
Michael T. Embry
PO Box 78, 1450 Wilson Creek Rd
STATE
Boston
TEST ADMINISTRATION NUMBER
ZIP
KY
40107
DATE YOU INTEND TO TAKE THE CCO EXAMINATION
KY21736
August 27, 2016
I declare that the foregoing statements and those in any required accompanying documentation are true. I understand
and agree that my failure to provide accurate and complete information or abide by NCCCO’s policies and procedures,
including the Code of Ethics, shall constitute grounds for the rejection of my application, or denial or revocation of my
certification. I understand that NCCCO reserves the right to verify any information in this application or in connection
with my certification. I consent to NCCCO’s release of any information regarding this application and my examination
administration to third parties, consistent with NCCCO’s Information Release policy. I have received a copy of the NCCCO
Candidate Handbook, have read it, and agree to be bound by it. I also agree to be bound by all NCCCO policies and
procedures, as they may be amended from time to time, including without limitation those posted at nccco.org. I attest
that I have passed a substance abuse test conducted by a recognized laboratory service and agree to comply with NCCCO’s
substance abuse policy. I have passed a physical exam that complies with the ASME B30 standard for my certification designation and I will continue to comply with those requirements. I understand that if at any point during my certification
period I fail to meet any of the requirements outlined above, or if matters arise that can affect my capability to continue
to fulfill certification requirements, I must report it to NCCCO immediately and agree to cooperate with any subsequent
investigation regarding such matters.
CANDIDATE SIGNATURE
DATE
METHOD OF PAYMENT FOR CANDIDATE EXAMINATION FEES



 Personal check  Employer check
enclosed
enclosed
Do not send cash.
 Money Order
enclosed
Please do not
staple your check
or money order.
If paying by credit card, complete the following information:
EXPIRATION DATE
CREDIT CARD NUMBER
NAME (Print as it appears on card)
SIGNATURE (on card)
SECURITY CODE*
* Three- or four-digit code located on the card.
Checks and money orders should be payable to: NCCCO
Please send application and payments to:
IUOE Local 181 JATC
PO Box 78
Boston, KY 40107
Phone: 502-833-2358
Fax: 502-833-3224
Email: [email protected]
28
Copyright 1996–2016 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 06/16
Recertification Application
WRITTEN EXAMINATION—MOBILE, TOWER, & OVERHEAD
CRANE OPERATOR (PAPER/PENCIL TESTS ONLY)
Please type or print neatly.
FULL LEGAL NAME
(as shown on driver’s license)
First
Middle
CCO CERTIFICATION NUMBER
Last
DATE OF BIRTH
Suffix (Jr., Sr., III)
SOCIAL
SECURITY #
CITY
MAILING ADDRESS
PHONE
CELL
STATE
FAX
ZIP
E-MAIL
COMPANY/ORGANIZATION
PHONE
IUOE Local 181
COMPANY MAILING ADDRESS
270-826-2704
CITY
PO Box 34
STATE
Henderson
KY
ZIP
42419
 I AM REQUESTING TESTING ACCOMMODATIONS IN COMPLIANCE WITH THE AMERICAN WITH DISABILITIES ACT (ADA).
(For details on NCCCO’s Testing Accommodations policy, please see www.nccco.org/accommodations.)
WRITTEN EXAMINATIONS FOR WHICH YOU ARE APPLYING
This application is for recertification only. You may ONLY recertify for the designation(s) in which you are currently certified.
FILL IN the circle next to the crane type(s) for which you are applying for recertification. If you would like to take Additional
Examinations for cranes that you are not currently certified on, then FILL IN the examinations of your choice and CHECK the load
chart you want to use for that crane type.
EXAMINATIONS
RECERTIFICATION EXAMS
LOAD CHARTS
PP Core Exam
652605 (Check one for each Specialty Exam)
PP Lattice Boom Crawler 652625 Terex/American
(LBC)652608
Manitowoc
PP Lattice Boom Truck 652611 Link-Belt
(LBT)
652635
Manitowoc
PP Telescopic Boom— 652614  Grove (Truck Mount)
Swing Cab (TLL)
652645  Link-Belt (Rough Terrain)
PP Telescopic Boom— 652656  Manitex (Boom Truck)
Fixed Cab (TSS)
652665  Shuttlelift (Carry Deck)
PP Tower Crane
654602
PP Overhead Crane
653602
ADDITIONAL EXAMINATIONS
LOAD CHARTS
(Check one for each Specialty Exam)
PP Lattice Boom Crawler 652620 Terex/American
(LBC)652607
Manitowoc
PP Lattice Boom Truck 652609 Link-Belt
(LBT)
652610
Manitowoc
PP Telescopic Boom— 652612  Grove (Truck Mount)
Swing Cab (TLL)
652613  Link-Belt (Rough Terrain)
PP Telescopic Boom— 652616  Manitex (Boom Truck)
Fixed Cab (TSS)
652660  Shuttlelift (Carry Deck)
PP Boom Truck—Fixed 652671  Manitex (Boom Truck)
Cab (BTF)
PP Tower Crane
654601
PP Overhead Crane
653601
RECERTIFICATION EXAM FEES/RETEST FEES
PP Mobile Core Exam plus one Specialty Exam.................... $150
PP Mobile Core Exam plus two Specialty Exams.................. $155
PP Mobile Core Exam plus three Specialty Exams................ $160
PP Mobile Core Exam plus four Specialty Exams.................. $165
PP Tower Crane (only)........................................................ $150
PP Tower Crane (with Mobile Crane)..................................... $50
PP Overhead Crane (only)................................................... $150
PP Overhead Crane (with Mobile Crane)............................... $50
PP Mobile Core Exam or Core plus one Specialty Exam
(Retest)......................................................................... $150
PP One Mobile Specialty Exam (Retest)................................. $50
PP Two Mobile Specialty Exams (Retest)................................ $55
PP Three Mobile Specialty Exams (Retest).............................. $60
PP Four Mobile Specialty Exams (Retest)............................... $65
ADDITIONAL EXAM FEES*
(*ONLY for candidates adding to existing Mobile certifications;
for candidates adding Mobile to Tower or Overhead certifications, use standard Written Exam Candidate Application form.)
PP One Mobile Specialty Exam.............................................. $65
PP Two Mobile Specialty Exams............................................ $75
PP Three Mobile Specialty Exams ......................................... $85
PP Tower Crane Exam........................................................... $50
PP Overhead Crane Exam..................................................... $50
PP Candidate Late Fee (if applicable).................................... $50
PP Incomplete Application Fee (if applicable)......................... $30
TOTAL AMOUNT DUE . . . . . . . . . . . . . .
Copyright 1996–2016 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 06/16
$
31
CANDIDATE RECERTIFICATION APPLICATION (CONT’D)
WRITTEN EXAMINATION—MOBILE, TOWER, & OVERHEAD CRANE OPERATOR
TEST SITE AT WHICH YOU INTEND TO TAKE THE WRITTEN EXAMINATION
TEST SITE NAME
TEST SITE ADDRESS
CITY
TEST SITE COORDINATOR
IUOE Local 181 JATC
Michael T. Embry
PO Box 78, 1450 Wilson Creek Rd
Boston
ZIP
STATE
KY
TEST ADMINISTRATION NUMBER
DATE YOU INTEND TO TAKE THE CCO EXAMINATION
KY21736
40107
August 27, 2016
SS I do NOT have 1,000 hours of documented crane-related experience and must take an CCO Practical Exam for each designation for which I wish to be recertified.
I declare that the foregoing statements and those in any required accompanying documentation are true. I understand and agree that my
failure to provide accurate and complete information or abide by NCCCO’s policies and procedures, including the Code of Ethics, shall
constitute grounds for the rejection of my application, or denial or revocation of my certification. I understand that NCCCO reserves the right to
verify any information in this application or in connection with my certification. I consent to NCCCO’s release of any information regarding this
application and my examination administration to third parties, consistent with NCCCO’s Information Release policy. I have received a copy
of the NCCCO Candidate Handbook, have read it, and agree to be bound by it. I also agree to be bound by all NCCCO policies and procedures,
as they may be amended from time to time, including without limitation those posted at nccco.org. I attest that I have passed a substance
abuse test conducted by a recognized laboratory service and agree to comply with NCCCO’s substance abuse policy. I have passed a physical
exam that complies with the ASME B30 standard for my certification designation and I will continue to comply with those requirements. I
further affirm either that I have maintained at least 1,000 hours of crane-related experience in the past five years or, if I have not maintained
this experience, I have checked the box above this panel indicating that before my certification expires I will take and pass a practical exam
for each designation for which I wish to be recertified. I understand that if at any point during my certification period I fail to meet any of the
requirements outlined above, or if matters arise that can affect my capability to continue to fulfill certification requirements, I must report it to
NCCCO immediately and agree to cooperate with any subsequent investigation regarding such matters.
CANDIDATE SIGNATURE
DATE
METHOD OF PAYMENT FOR CANDIDATE EXAMINATION FEES



Do not send cash.
 Personal check  Employer check
enclosed
enclosed
 Money order
enclosed
Please do not
staple your check
or money order.
If paying by credit card, complete the following information:
EXPIRATION DATE
CREDIT CARD NUMBER
NAME (Print as it appears on card)
SIGNATURE (on card)
SECURITY CODE*
Checks and money orders should be payable to: NCCCO
Please send application and payment to:
* Three- or four-digit code located on the card.
IUOE Local 181 JATC
PO Box 78
Boston, KY 40107
Phone: 502-833-2358
Fax: 502-833-3224
Email: [email protected]
CANDIDATE APPLICATION CHECKLIST
SS I have completed and signed the Candidate Application.
SS I have provided credit card information or a check or money order for the correct amount due.
SS I have submitted a color digital photo (full face, no sunglasses, no hat). A passport photo may
be substituted for a digital photo.
For additional information regarding recertification, contact:
National Commission for the Certification of Crane Operators (NCCCO)
2750 Prosperity Avenue, Suite 505
Phone: 703-560-2391
Fairfax, VA 22031
Fax: 703-560-2392
32
Attach Color
Passport Photo
Here
1-3/8” W x 1-3/4” H
[email protected]
www.nccco.org
Copyright 1996–2016 National Commission for the Certification of Crane Operators. All rights reserved. MCO CH REV 06/16
Candidate Application
WRITTEN EXAMINATIONS—LIFT DIRECTOR
(PAPER/PENCIL TEST ONLY)
Please type or print neatly.
FULL LEGAL NAME
(as shown on driver’s license)
First
Middle
Last
Suffix (Jr., Sr., III)
CCO CERTIFICATION NUMBER (if previously certified)
SOCIAL
SECURITY #
CITY
MAILING ADDRESS
PHONE
CELL
COMPANY/ORGANIZATION
COMPANY MAILING ADDRESS
IUOE Local 181
DATE OF BIRTH
STATE
FAX
EMAIL
PHONE
CITY
PO Box 34
ZIP
270-826-2704
STATE
Henderson
ZIP
KY
42419
 I AM REQUESTING TESTING ACCOMMODATIONS IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT (ADA).
(For details on NCCCO’s Testing Accommodations policy, please see www.nccco.org/accommodations)
ARE YOU A CURRENTLY CCO-CERTIFIED CRANE OPERATOR IN GOOD STANDING?  Yes  No
If you checked "yes" above, what is your CCO operator certification number? ____________________________
Also please indicate the cranes you are certified to operate:  Mobile Cranes
 Tower Cranes
WRITTEN EXAMINATION(S) FOR WHICH YOU ARE APPLYING
FILL IN the circle next to the crane type(s) for which you are applying. Total the amount due at bottom.
WRITTEN EXAMS
WRITTEN EXAM/RETEST FEES
PP Lift Director Core Exam 811101
LIFT DIRECTOR EXAMS
PP Lift Director Mobile
Crane Specialty
811201
PP Lift Director Tower
Crane Specialty
811301
PP Lift Director Core Exam.................................................. $150
PP Lift Director Mobile Crane Specialty............................. $150
PP Lift Director Tower Crane Specialty............................... $150
PP Mobile Crane Operator LOAD CHARTS
Core Exam
652603 (Check one for each Specialty Exam)
PP Lattice Boom Crawler 652620 American LBC
Specialty
652607 Manitowoc LBC
PP Lattice Boom Truck
Specialty
652609 Link-Belt LBT
652610 Manitowoc LBT
PP Telescopic Boom—
Swing Cab Specialty
652612 Grove TLL (Truck Mount)
652613 Link-Belt TLL (Rough Terrain)
PP Telescopic Boom—
Fixed Cab Specialty
652616 Manitex TSS (Boom Truck)
652660 Shuttlelift (Carry Deck)
PP Tower Crane Operator 654601
PP Rigger Level II
652802
OTHER FEES
PP Candidate Late Fee (if applicable).................................... $50
PP Incomplete Application Fee (if applicable)......................... $30
PP Updated/Replacement Card............................................. $25
ADD TO TOTAL AMOUNT AT RIGHT
MOBILE CRANE OPERATOR EXAMS
PP Core Exam plus one Specialty Exam (Initial or Retest)..... $165
PP Core Exam plus two Specialty Exams (Initial or Retest).... $175
PP One Specialty Exam (Retest or Added Specialty)................ $65
PP Two Specialty Exams (Retest or Added Specialty).............. $75
TOWER CRANE OPERATOR EXAM
PP Tower Crane Written Exam (new Candidate)................... $165
PP Tower Crane Written Exam (current CCO-certified
Mobile Crane Operator, or new candidate taking
exam same time as Mobile Crane exams)......................... $50
RIGGER LEVEL II EXAM
PP Rigger Level II Written Exam (new Candidate).................. $95
PP Rigger Level II Written Exam (current CCO certified card holder or new candidate
taking exam same time as Lift Director exams)................. $75
TOTAL AMOUNT DUE . . . . . . . . . . . $
For logistical reasons, and in fairness to each candidate, it is not recommended that a candidate schedule written exams totaling more than six
hours of testing time on the same day.
Copyright 2013–2016 National Commission for the Certification of Crane Operators. All rights reserved. LDCH REV 06/16
19
CANDIDATE APPLICATION (CONT’D)
LIFT DIRECTOR WRITTEN EXAMINATION(S)
TEST SITE AT WHICH YOU INTEND TO TAKE THE WRITTEN EXAMINATION
TEST SITE NAME
TEST SITE COORDINATOR
IUOE Local 181 JATC
Michael T. Embry
TEST SITE ADDRESS
CITY
PO Box 78, 1450 Wilson Creek Rd
STATE
Boston
ZIP
KY
TEST ADMINISTRATION NUMBER
40107
DATE YOU INTEND TO TAKE THE CCO EXAMINATION
KY21736
August 27, 2016
I declare that the foregoing statements and those in any required accompanying documentation are true. I understand and agree that my
failure to provide accurate and complete information or abide by NCCCO’s policies and procedures, including the Code of Ethics, shall
constitute grounds for the rejection of my application, or denial or revocation of my certification. I understand that NCCCO reserves the
right to verify any information in this application or in connection with my certification. I consent to NCCCO’s release of any information
regarding this application and my examination administration to third parties, consistent with NCCCO’s Information Release policy.
I have received a copy of the NCCCO Candidate Handbook, have read it, and agree to be bound by it. I also agree to be bound by all
NCCCO policies and procedures, as they may be amended from time to time, including without limitation those posted at nccco.org. I
have passed a substance abuse test conducted by a recognized laboratory service and agree to comply with NCCCO’s substance abuse
policy. I attest that I am in good physical health, as verified by a medical professional, sufficient enough to handle the physical demands
that directing lifts requires. I understand that if at any point during my certification period I fail to meet any of the requirements
outlined above, or if matters arise that can affect my capability to continue to fulfill certification requirements, I must report it to NCCCO
immediately and agree to cooperate with any subsequent investigation regarding such matters.
CANDIDATE SIGNATURE
DATE
CCO CERTIFICATION CARD
Candidates who meet all the requirements for certification in any one
designation are issued a certification card at no charge. Replacement and
updated cards are available for an additional fee; see panel below.
Attach Color
Passport Photo
Here
Please coordinate with the Test Site Coordinator/Practical Examiner for
the submission of a digital color photo (without hat or sunglasses) and
enclose with your application form any required payment based upon the
information listed below.
1-3/8” W x 1-3/4” H
A passport color photo may be substituted for a digital photo.
METHOD OF PAYMENT FOR CANDIDATE EXAMINATION FEES



Do not send cash.
 Personal check  Employer check
enclosed
enclosed
 Money Order
enclosed
Please do not
staple your check
or money order.
If paying by credit card, complete the following information:
EXPIRATION DATE
CREDIT CARD NUMBER
NAME (Print as it appears on card)
SIGNATURE (on card)
SECURITY CODE*
* Three- or four-digit code located on the card.
Checks and money orders should be payable to: NCCCO
Please send application and payments to:
IUOE Local 181 JATC
PO Box 78
Boston, KY 40107
20
Email: [email protected]
Phone: 502-833-2358
Fax: 502-833-3224
Copyright 2013–2016 National Commission for the Certification of Crane Operators. All rights reserved. LDCH REV 06/16
Change of Address Form
Please use this form to advise of any changes of address. Please mail, fax, or email this completed form to:
NCCCO
1960 Bayshore Blvd.
Dunedin, Florida 34698
Phone: 727-449-8525
Fax: 727-461-2746
Email: [email protected]
Please type or print neatly.
NAME
First
Middle
CCO CERTIFICATION NUMBER (IF PREVIOUSLY CERTIFIED)
Last
SOCIAL SECURITY #
OLD ADDRESS
MAILING ADDRESS
CITY
PHONE
COMPANY / ORGANIZATION
COMPANY MAILING ADDRESS
CITY
ZIP
STATE
FAX
IUOE Local 181
EMAIL
PHONE
270-826-2704
PO Box 34
STATE
Henderson
KY
ZIP
42419
NEW ADDRESS
MAILING ADDRESS
CITY
PHONE
COMPANY / ORGANIZATION
COMPANY MAILING ADDRESS
CITY
ZIP
STATE
FAX
IUOE Local 181
PO Box 34
Henderson
EMAIL
PHONE
STATE
270-826-2704
KY
ZIP
42419
EFFECTIVE DATE OF CHANGE
Copyright 2010–2016 National Commission for the Certification of Crane Operators. All rights reserved. ACO CH REV 06/16
37
Physical Examination Form
All OPERATOR programs
Please type or print neatly.
NAME
First
Middle
SOCIAL SECURITY #
Last
DATE OF EXAMINATION
MAILING ADDRESS
phone
cITY
STATE
zip
HEALTH HISTORY
Yes No
SS
SS
SS
SS
SS
SS
SS







Asthma
Kidney
Tuberculosis
Diabetes
Nervous stomach
Rheumatic fever
Over-the-counter drug
Yes No
SS
SS
SS
SS
SS
SS
SS







Yes No
Muscular disease
Psychiatric
Cardiovascular disease
Gastrointestinal ulcer
Ethanol use
Rx drug use
Head or spinal
SS  Seizures, fits, convulsions, or fainting
SS  Extensive confinement by illness or
injury
SS  Any other nervous disorder
SS  Suffering from any other disorder
SS  Permanent defect from illness, disease,
or injury
If answer to any of the above is yes, please explain
GENERAL APPEARANCE AND DEVELOPMENT:  Good
 Fair
 Poor
VISION: For distance
 Right/20
 Left/20
 Both/20
 Without corrective lenses
 With corrective lenses
Evidence of disease or injury:
Right ____________________ Left _____________________
Color test:
Right ____________________ Left _____________________
Horizontal field of vision:
Right ____________________ Left _____________________
HEARING: Right ear_ _________________________________ Evidence of disease or injury:
AUDIOMETRIC TEST:  500 HZ
Left ear __________________________________
Right ear_ ________________ Left ear___________________
 1000 HZ
 5000 HZ
 3000 HZ
 7000 HZ
 2000 HZ
 6000 HZ
 4000 HZ
 8000 HZ
THROAT:
_____________________________________________________________________________________
THORAX:
Heart:_________________________________________________________________________________
If organic disease is present, is it fully compensated? _____________________________________________
Blood pressure:
Pulse:
Lungs:_ _______________________________________________________________________________
Systolic_ _____________________ Diastolic ______________________
Before exercise_ ____________________ Immediately after _ _________________________
ABDOMEN: Scars______________________ Abdominal masses _ ___________________ Tenderness______________
Copyright 1996–2013 National Commission for the Certification of Crane Operators. All rights reserved. TSCH-W REV 07/13
39
Physical examination form (Cont’d)
HERNIA:
 Yes
 No
If so, where? _________________________ Is truss worn? __________________
GASTROINTESTINAL: Ulceration or other disease?
GENITO-URINARY:  Yes____________________  No_ ___________________
Scars_ __________________________ Urinal discharge _________________________
REFLEXES:
Rhomberg_ _________________________________________________________________________
Pupillary_____________________ Light: Right___________________ Left ________________________
Accommodation____________________ Right___________________ Left ________________________
KNEE JERKS:
Right
Normal_ ______________ Increased__________________ Absent______________________
Left
Normal_ ______________ Increased__________________ Absent______________________
REMARKS:
_ __________________________________________________________________________________
EXTREMITIES: Upper_____________________ Lower_ _____________________ Spine_________________________
LABORATORY &
OTHER SPECIAL
FINDINGS:
Urine Spec. Gr._ _____________________ Alb._ ___________________ Sugar___________________
Other Laboratory Data (Serology, etc.) _ _________________________________________________
Radiological Data__________________ Electrocardiograph________________________________
GENERAL
_ __________________________________________________________________________________
COMMENTS: _ __________________________________________________________________________________
_ __________________________________________________________________________________
NAME of examining doctor (Please print)
Signature
ADDRESS of examining doctor
cITY
STATE
zip
MEDICAL EXAMINER’S CERTIFICATE (ONLY TO BE COMPLETED IF OPERATOR IS FOUND QUALIFIED)
MEDICAL EXAMINER’S CERTIFICATE
MEDICAL EXAMINER’S CERTIFICATE
I certify that I have examined
I certify that I have examined
CRANE OPERATOR’S NAME
CRANE OPERATOR’S NAME
with the knowledge of his/her duties,
I find him/her qualified under the regulations.
with the knowledge of his/her duties,
I find him/her qualified under the regulations.
SS Qualified only when wearing corrective lenses
SS Qualified only when wearing corrective lenses
SS Qualified only when wearing a hearing aid
SS Qualified only when wearing a hearing aid
SS Qualified—see Accommodation Statement attached
SS Qualified—see Accommodation Statement attached
A complete examination form for this person is on file in my office:
A complete examination form for this person is on file in my office:
ADDRESS
DATE OF EXAMINATION
40
ADDRESS
name of examining doctor
DATE OF EXAMINATION
name of examining doctor
Signature of examining doctor
Signature of examining doctor
Signature of operator
Signature of operator
Address of operator
Address of operator
Copyright 1996–2013 National Commission for the Certification of Crane Operators. All rights reserved. TSCH-W REV 07/13
Physician Instructions
Please give these instructions to the
examining physician
PHYSICAL QUALIFICATIONS AND EXAMINATIONS OF
OPERATORS
amounts), look-alike drugs, designer drugs, or any other
substance that may have the effect on the human body of being
a narcotic, depressant, stimulant, or hallucinogen. An exception
to this ruling is that an operator may use such a substance or
drug if the substance or drug is prescribed by a licensed medical
practitioner who is familiar with the operator’s medical history
and all assigned duties and who has advised the operator that
the prescribed substance or drug will not adversely affect the
operator’s ability to safely operate a crane/digger derrick. The
treating physician will also provide a waiver to the Medical
Examiner. (See waiver statement.)
A person is physically qualified to operate a crane/digger derrick if
that person:
1. Has no loss of a foot, a leg, a hand, or an arm, or has been
granted a waiver
2. Has no impairment of the use of a foot, a leg, a hand, fingers,
or an arm, and no other structural defect or limitation, which
is likely to interfere with his/her ability to control and safely
operate a crane/digger derrick or has been granted a waiver
upon a determination that the impairment will not interfere
with his/her ability to control and safely operate a crane/digger
derrick
3. Has no established medical history or clinical diagnosis of
diabetes mellitus currently requiring insulin for control
4. Has no current clinical diagnosis of myocardial infarction,
angina pectoris, coronary insufficiency, thrombosis, or any other
cardiovascular disease of a variety to be known accompanied by
syncope, dyspnea, collapse, or congestive cardiac failure
5. Has no established medical history or clinical diagnosis of
respiratory dysfunction likely to interfere with his/her ability to
control and operate a crane/digger derrick safely
6. Has no current clinical diagnosis of high blood pressure likely to
interfere with his/her ability to operate a crane/digger derrick
7. Has no established medical history or clinical diagnosis of
rheumatic, arthritic, orthopedic, muscular, neuromuscular, or
vascular disease that interferes with his/her ability to control
and operate a crane/digger derrick safely
8. Has no established medical history or clinical diagnosis of
epilepsy or any other condition that is likely to cause loss of
consciousness or any loss of ability to control a crane/digger
derrick
9. Has no mental, nervous, organic, or functional disease or
psychiatric disorder likely to interfere with his/her ability to
operate a crane/digger derrick
10. Has distant visual acuity of at least 20/40 (Snellen) in each eye
without corrective lenses or visual acuity separately corrected
to 20/40 (Snellen) or better with corrective lenses, distant
binocular acuity of at least 20/40 (Snellen) in both eyes with or
without corrective lenses, field of vision of at least 70 degrees in
the horizontal median in each eye, and the ability to recognize
the colors of traffic signals and devices showing standard red,
green, and amber
11. When tested by use of an audiometric device, does not have an
average hearing loss in the better ear greater than 40 decibels
at 500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz and 4,000 Hz with or
without a hearing aid when the audiometric device is calibrated
to American National Standard (formerly ASA Standard)
Z24.5-1951
12. Does not use a prescribed or over-the-counter substance,
including ethanol, which would impair the operator’s
performing safe operation of a crane/digger derrick. These
include illegal drugs, controlled substances (including trace
INSTRUCTIONS FOR PERFORMING AND RECORDING
PHYSICAL EXAMINATIONS
The examining physician should review these instructions before
performing the physical examination. Answer each question yes or
no, where appropriate.
The examining physician should be aware of the rigorous physical
demands and mental and emotional responsibilities placed on
operators. In the interest of public safety, the examining physician
is required to certify that the operator does not have any physical,
mental, or organic defect of such a nature as to affect the operator’s
ability to operate a crane/digger derrick safely.
General Information. The purpose of this history and physical
examination is to detect the presence of physical, mental, or organic
defects of such a character and extent as to affect the applicant’s ability to operate a crane/digger derrick safely. The examination should
be made carefully and at least as completely as indicated by the
attached form. History of certain defects may be cause for rejection
or indicate the need for making certain laboratory tests or a further,
and more stringent, examination. Defects may be recorded that do
not, because of their character or degree, indicate that certification of
physical fitness should be denied. However, these defects should be
discussed with the applicant and he/she should be advised to take
the necessary steps to ensure correction, particularly of those which,
if neglected, might lead to a condition likely to affect his/her ability to
operate safely.
General Appearance and development. Not marked overweight. Not
any posture defect, perceptible limp, tremor, or other defects that
might be caused by alcoholism, thyroid intoxication, or other illnesses
including sedating or habit-forming drugs.
Head—eyes. When other than the Snellen chart is used, the results
of such test must be expressed in values comparable to the standard
Snellen test. If the applicant wears corrective lenses, these should be
worn while applicant’s visual acuity is being tested. If appropriate,
indicate on the Medical Examiner’s Certificate by checking the box
Qualified only when wearing corrective lenses. In recording distance
vision, use 20 feet as normal. Report all vision as a fraction with 20
as a numerator and the smallest type read at 20 feet as denominator.
Note ptosis, discharge, visual fields, ocular muscle imbalance, color
blindness, corneal scar, exophthalmos, or strabismus uncorrected by
corrective lenses.
Contact lens wear may not be allowed in many work areas where
mandatory eye protection disallows contact lens wear. The applicant
Copyright 1996–2013 National Commission for the Certification of Crane Operators. All rights reserved. TSCH-W REV 07/13
41
must be made aware that safety glass eye wear may routinely be
required at job sites and must also pass vision testing protocols with
safety eye glasses specified and approved ANSI Z89.
Ears. Note evidence of mastoid of middle ear disease, discharge,
symptoms of aura vertigo, or Meniere’s Syndrome. When recording
hearing an audiometer is used to test hearing. Record decibel loss at
500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz, and 4,000 Hz.
Throat. Note evidence of disease, irremediable deformities of the
throat likely to interfere with eating or breathing, or any laryngeal
condition that could interfere with the safe operation of a crane/
digger derrick.
Thorax—heart. Stethoscopic examination is required. Note murmurs
and arthythmias and any past or present history of cardiovascular
disease of a variety known to be accompanied by syncope, dyspnea,
collapse, enlarged heart, or congestive heart failures. An electrocardiogram is required when findings so indicate.
Blood Pressure. Record with either spring or mercury column type
of sphygmomanometer. If the blood pressure is consistently above
160/90mm. Hg., further tests may be necessary to determine whether
the operator is qualified to operate a crane/digger derrick.
Lungs. If any lung disease is detected, state whether active or
arrested; if arrested, your opinion as to how long it has been
quiescent.
Gastrointestinal system. Note any diseases of the gastrointestinal
system.
Abdomen. Note wounds, injuries, scars, or weakness of muscles of
abdominal walls sufficient to interfere with normal function. Any
hernia should be noted if present. State how long and if adequately
contained by truss.
Abnormal masses. If present, note location, if tender, and whether or
not applicant knows how long they have been present. If the diagnosis suggests that the condition might interfere with the control and
safe operation of a crane/digger derrick, more stringent tests must be
made before the applicant can be certified.
Genitourinary. Urinalysis is required. Acute infections of the
genitourinary tract, as defined by local and state public health laws,
indications from urinalysis of uncontrolled diabetes, symptomatic
albuminurea in the urine, or other findings indicative of health conditions likely to interfere with the control and safe operation of a crane/
digger derrick will disqualify an applicant from operating a crane/
digger derrick.
Neurological. If positive Rhomberg is reported, indicate degrees of
impairment. Pupillary reflexes should be reported for both light and
accommodation.
Knee jerks are to be reported absent only when not obtainable upon
reinforcement and as increased when foot is actually lifted from the
floor following a light blow on the patella; sensory vibratory and
positional abnormalities should be noted.
Extremities. Carefully examine upper and lower extremities. Record
the loss or impairment of a leg, foot, toe, arm, hand, or fingers. Note
any and all deformities, the presence of atrophy, semiparalysis or
paralysis, or varicose veins. If a hand or finger deformity exists,
determine whether sufficient grasp is present to enable the operator to secure and maintain a grip on the controls. If a leg deformity
exists, determine whether sufficient mobility and strength exists to
enable the operator to operate pedals properly. Particular attention
should be given to, and a record should be made of, any impairment
42
or structural defect that may interfere with the operator’s ability to
operate a crane/digger derrick safely.
Spine. Note deformities, limitation of motion, or any history of pain,
injuries, or disease, past or presently experienced in the cervical
or lumbar spine region. If findings so dictate, radiologic and other
examinations should be used to diagnose congenital or acquired
defects, spondylolisthesis, or scoliosis.
Recto-genital studies. Diseases or conditions causing discomfort
should be evaluated carefully to determine the extent to which the
condition might be handicapping while lifting, pulling, or during
periods of prolonged operation that might be necessary as part of the
operator’s duties.
Laboratory and other special findings. Urinalysis is required, as well
as such other tests as the medical history or findings upon physical
examination may indicate are necessary. A serological test is required
if the applicant has a history of luetic infection or present physical
findings indicate the possibility of latent syphilis. Other studies
deemed advisable may be ordered by the examining physician.
Diabetes. If insulin is necessary to control a diabetic condition, the
operator is not qualified to operate a crane/digger derrick. If mild diabetes is noted at the time of examination and it is stabilized by use of
a hypoglycemic drug and a diet that can be obtained while the operator is on duty, it should not be considered disqualifying. However, the
operator must remain under adequate medical supervision.
General. The physician must date and sign his findings upon completion of the examination.
The medical examination shall be performed by a licensed doctor of
medicine or osteopathy. A licensed ophthalmologist or optometrist
may perform examinations pertaining to visual acuity, field of vision,
and ability to recognize colors.
If the medical examiner finds that the person he/she examined is
physically qualified to operate a crane/digger derrick, the medical
examiner shall complete the Medical Examiner’s Certificate and furnish one copy to the person examined and one copy to the employer.
The medical examiner must attach all treating physician, ophthalmologist, or optometrist medical information pertaining to the applicant.
Waiver acceptance is up to the medical examiner when waiver is
attached to applicant application. The medical examiner is expected
to verify the waiver provided by treating physician and qualify or
disqualify applicant because of his examination of the applicant.
The medical examiner is expected to perform testing as needed of all
applicants and may submit an accommodation statement, if applicable, about an applicant’s physical limitations to aid an employer with
ADA guidelines. Any accommodation statements must be attached to
medical artifaction.
Waiver by physician. Treating physicians must provide signed statements disclosing disease state and/or medication and state, “I have
examined the aforementioned operator applicant and within medical certainty I find the applicant at no greater risk than the general
population as a result of any physical, mental, or organic defects,
and can safely operate a crane/digger derrick with the aforementioned diagnosis and treatment regimen subject to passing the CCO
examinations.”
Copyright 1996–2013 National Commission for the Certification of Crane Operators. All rights reserved. TSCH-W REV 07/13
International Union of Operating Engineers, Local 181
JOINT APPRENTICESHIP AND TRAINING PROGRAM
IUOE Local 181, Indiana Constructors, Inc., Associated General Contractors of Indiana (Southwestern Branch),
And Highway Contractors, Inc.
From the Office of:
□ Lynnville Training Site
722 E. S.R. 68
Lynnville, IN 47619
Phone: 812-922-5541
Fax:
812-922-5018
From the Office of:
■ Boston Training Site
P.O. Box 78
1450 Wilson Creek Rd.
Boston, KY 40107
Phone: 502-833-2358
Fax: 502-833-3224
□ Master Records and Bookkeeping Office
P.O. Box 34 ● Henderson, KY 42419-0034
Phone: 270-826-2704 ● Fax: 270-827-2014
Notice to NCCCO Candidate
Reimbursement Procedure
Dear Local 181 Member:
Please be advised that the JATC Board revised the NCCCO Reimbursement Policy May 23, 2011 as follows:
Reimbursement will be processed when the training site has received notification that a passing grade has been
awarded for both the written and practical exams and the member has provided a copy of their NCCCO
certification card to the training site.
Please mail a copy of the front side of your NCCCO Certification Card when received to:
IUOE Local 181 JATC
PO Box 78
Boston KY 40107
Or take a photo/scan and e-mail a copy to:
[email protected]
Fax copies are not recommended. All dates and numbers must be legible for reimbursement to be processed.
It is recommended that you also send a copy of your test scores. Scores must be included for all exams taken at
a location other than either of the Local 181 Training Sites i.e. Computer Based Testing (CBT) Exams and
Tower/Overhead Practical Exams taken at another Local in order for mileage reimbursement that may be due
to be processed.
Please note, all NCCCO Reimbursements are processed by the Boston Training Site. You must be a member in
good standing to receive reimbursement.
Please call the Boston training site at 502-833-2358 if you have any questions.
Thank you in advance,
IUOE Local 181 JATC
Boston Training Site
Directions to IUOE Local 181 Boston Training Site for Members not eligible for motel accommodations:
Physical Address: 1450 Wilson Creek Rd, Boston KY 40107
Phone: 502-833-2358
Office Hours: Monday through Friday, 7:00 a.m. to 3:30 p.m. EST
From Southern Indiana / Louisville Area: Take I-65 South toward NASHVILLE. Take the KY-61 exit –
EXIT 105- toward BOSTON / LEBANON JCT. Take the ramp toward BOSTON. Turn LEFT onto KY-61.
Turn LEFT onto US-62 (at caution light, stop sign, road T’s). Follow US-62 ½ mile, turn LEFT onto KY-733
(If you pass the Dollar General, you went too far). Go 1 ½ miles, Training Site will be on your right.
From Western KY / Paducah Area: Take Western KY Parkway to I-65 North. Take the KY-61 exit – EXIT
105- toward BOSTON / LEBANON JCT. Take the ramp toward BOSTON. Turn LEFT onto KY-61. Turn
LEFT onto US-62 (at caution light, stop sign, road T’s). Follow US-62 ½ mile, turn LEFT onto KY-733 (If
you pass the Dollar General, you went too far). Go 1 ½ miles, Training Site will be on your right.
From Eastern KY /Ashland Area – through Lexington: Merge onto I-64 W. Take the US-27 / US-68 exit,
EXIT 113, toward Paris / Lexington. Turn right onto N Broadway / US-27 S / US-68 W. Turn right onto W
New Circle Rd / US-25-BYP N / US-60-BYP W / US-421-BYP N / KY-4 W. Merge onto US-60 W via EXIT
5B toward Martha Layne Collins Bluegrass Parkway. Take the Martha Layne Collins Bluegrass Parkway W
ramp toward LAWRENCEBURG / ELIZABETHTOWN. Take the KY-52 exit – EXIT 10- toward NEW
HAVEN / BOSTON. Turn RIGHT onto KY-52. Go approx. 2 miles and Turn RIGHT onto US-62. (Go
through Boston; pass the Boston Food Mart and 61/62 intersection at the caution light). Turn LEFT onto KY733 (first road on the left after the caution light). (If you pass the Dollar General, you went too far). Go 1 ½
miles, Training Site will be on your right.
From South Eastern KY Area – through Danville/Bardstown: US-150-BYP W & US-150 Byp W become
US-150 W. Stay straight to go onto US-150-BYP N / S Danville Byp. Turn left onto US-150 / KY-52 /
Perryville Rd go ~ 24 miles. Turn left onto KY-555 go ~ 1.5 miles. Turn right onto Bardstown Rd / US-150
go ~ 16.5 miles. Enter roundabout and take the 2nd exit onto W Stephen Foster Ave / US-62. Go approx. 12
miles; turn RIGHT onto KY-733 (first road on the right past the Dollar General). Go approximately 1½ miles
and training site will be on your right.
General Nelson Inn (formerly Best Western)
411 W Stephen Foster Ave, Bardstown KY 40004
(502) 348-3977
From I-65 South (through Louisville)
Take I-65 South to KY-245 via EXIT 112 toward Clermont/Bardstown. Turn left off ramp; follow
KY-245 for 15.5 mi. Turn right onto N 3rd St / US-31E (at the Walgreens); follow for 1.2 mi. Enter
roundabout and take the 1st exit onto W Stephen Foster Ave. General Nelson Inn is on the left.
From Western Kentucky Pkwy E to I-65 North
Take the Western Kentucky Pkwy E to I-65 North EXIT 137B toward Lexington/Louisville (2.3
mi). Take the Bluegrass Pkwy via EXIT 93 toward Bardstown/Lexington (19.6 mi). Take US-31E
EXIT 21 toward Bardstown/Hodgenville. Keep LEFT to take the ramp toward Bardstown (2.1
mi). Turn LEFT onto W Stephen Foster Ave (US-62W). General Nelson Inn is on the left.
From General Nelson Inn to Boston Training Site
Turn LEFT out of General Nelson Inn onto US-62, travel approx. 11 miles, turn RIGHT onto KY733 (first road on the right past the Dollar General). Go approximately 1½ miles and training site
will be on your right.
General Nelson Inn (formerly Best Western)
411 W Stephen Foster Ave, Bardstown KY 40004
(502) 348-3977
From Eastern KY Area – through Lexington
Merge onto I-64 W. Take the US-27 / US-68 exit, EXIT 113, toward Paris / Lexington. Turn
right onto N Broadway / US-27 S / US-68 W. Turn right onto W New Circle Rd / US-25-BYP
N / US-60-BYP W / US-421-BYP N / KY-4 W. Merge onto US-60 W via EXIT 5B toward
Martha Layne Collins Bluegrass Parkway. Take the Martha Layne Collins Bluegrass Parkway
W ramp toward Lawrenceburg / Elizabethtown. Take the US-150 exit, EXIT 25, toward
Springfield / Bardstown. Turn right onto US-150, go ~ 2.2 miles. Enter roundabout and take the
2nd exit onto W Stephen Foster Ave. General Nelson Inn is on the left.
From South Eastern KY Area – through Danville
US-150-BYP W & US-150 Byp W become US-150 W. Stay straight to go onto US-150-BYP N
/ S Danville Byp. Turn left onto US-150 / KY-52 / Perryville Rd go ~ 24 miles. Turn left onto
KY-555 go ~ 1.5 miles. Turn right onto Bardstown Rd / US-150 go ~ 16.5 miles. Enter
roundabout and take the 2nd exit onto W Stephen Foster Ave. General Nelson Inn is on the left.
From General Nelson Inn to Boston Training Site
Turn LEFT out of General Nelson Inn onto US-62, travel approx. 11 miles, turn RIGHT onto
KY-733 (first road on the right past the Dollar General). Go approximately 1½ miles and
training site will be on your right.
DAYS INN of Elizabethtown
2010 N Mulberry St, Elizabethtown KY 42701
(270) 769-5522
From Louisville Area
Take I-65 South to the Elizabethtown exit #94;
turn left at end of ramp, Days Inn is on the left
by Denny’s and White Castle.
From Ashland / Eastern KY Area
In Lexington take the Martha Layne Collins
Bluegrass Parkway W to I-65 North to the
Elizabethtown exit #94, turn right at the end
of ramp and motel will be on the left by
Denny’s and White Castle.
From Paducah Area / Western KY Area
Take Western KY Parkway to I-65 North
to the Elizabethtown exit #94, turn right
at the end of ramp and motel will be on the
left by Denny’s and White Castle.
From Days Inn to Boston Training Site
Turn left out of Days Inn onto US 62,
travel approx. 11 miles, turn left onto KY-733.
(If you pass the Dollar General, you went too far),
go approximately 1½ miles and training site
will be on your right.