Form Pes 4012 PDF Details

In the landscape of professional engineering and surveying within Ohio, maintaining and documenting continuing professional development (CPD) is a cornerstone of ensuring that practitioners remain at the forefront of their field. The PES 4012 form plays a crucial role in this process, serving as the official log for engineers and surveyors to record their CPD activities for the purpose of Ohio P.E. and P.S. registration renewal. Mandated by the Ohio State Board of Registration for Professional Engineers and Surveyors, this form outlines the requirement for professionals to engage in at least fifteen hours of relevant CPD activities annually. Such activities must encompass technical, ethical, or managerial content that contributes to the practitioner’s knowledge and skills. The form also emphasizes the necessity of holding on to certificates of completion or other proof of participation, as stipulated by the Ohio Revised Code section 4733.151, despite the form's role in tracking CPD hours. Furthermore, it introduces the possibility of carrying over a maximum of 15 CPD hours to the following year, offering some flexibility in how professionals manage their development hours. With details about the activities' titles, dates, sponsors, and durations, as well as a section for affirming the accuracy of the recorded information, the PES 4012 form is foundational for Ohio's engineers and surveyors in adhering to continuous improvement and ensuring the reliability of their professional credentials.

QuestionAnswer
Form NameForm Pes 4012
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesContinuingEducation, cpd 4012 form, pes 4012 ohio, boardpes

Form Preview Example

OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS

 

Continuing professional development (CPD) activity log

4012

All CPD activities and courses must be relevant to the practice of engineering or surveying and must include technical, ethical or managerial content. This form is required for tracking your CPD hours for Ohio P.E. and P.S. registration annual renewal. This form does not replace copies of your certificates of completion or other documentation required by Ohio Revised Code section 4733.151. Fifteen CPD hours are required for Ohio registration renewal. A maximum carryover of 15 CPD hours are allowed per year. For information about the Board’s CPD requirements, go to our website at www.peps.ohio.gov/ContinuingEducation.aspx.

YOUR OHIO P.E., P.S. REGISTERED NAME AS IT IS ON YOUR LICENSE

 

 

P.E. NUMBER

 

 

P.S. NUMBER

FOR CALENDAR YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

0

 

0

 

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

SPONSOR /

 

 

 

LOCATION:

ACTIVITY TITLE,

 

 

 

 

 

CPD

DOCUMENTATION

[MM/DD]

PROVIDER

 

 

ADDRESS, CITY, STATE, ZIP

DESCRIPTION

INSTRUCTOR

 

EARNED

 

 

RECEIVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2008 CPD

 

TOTAL

TOTAL

 

The CPD credits listed herein are true and correct, and accurately state the professional development hours I have earned.

CARRIED OVER

 

2009 CPD

CPD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(MAXIMUM 15)

 

EARNED

EARNED

 

SIGNATURE

 

 

 

 

 

 

 

 

DATE SIGNED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State Board of Registration for Professional Engineers and Surveyors

50 West Broad Street, Suite 1820 • Columbus, Ohio 43215-5905

VOICE (614) 466-3651FAX (614) 728-3059U.S. TOLL FREE (877) 644-6364 (877) OHIO ENG EMAIL pes.board@pes.ohio.gov • WEB www.peps.ohio.gov

PES 4012 (Rev. 01/2009)

How to Edit Form Pes 4012 Online for Free

You can easily complete the pes 4012 ohio file using this PDF editor. The following actions will let you quickly prepare your document.

Step 1: On the page, choose the orange "Get form now" button.

Step 2: You can now edit your pes 4012 ohio. You should use the multifunctional toolbar to include, remove, and transform the content material of the file.

Type in the content requested by the application to fill in the form.

entering details in cpd 4012 form part 1

Fill in the CPD CARRIED OVER MAXIMUM, TOTAL CPD EARNED, TOTAL CPD EARNED, SIGNATURE, DATE SIGNED, State Board of Registration for, and PES Rev field with all the information asked by the software.

cpd 4012 form CPD CARRIED OVER MAXIMUM, TOTAL  CPD EARNED, TOTAL CPD EARNED, SIGNATURE, DATE SIGNED, State Board of Registration for, and PES  Rev blanks to complete

Step 3: When you click the Done button, your ready document can be transferred to all of your gadgets or to electronic mail stated by you.

Step 4: Create copies of your file. It will protect you from future problems. We cannot view or publish your data, for that reason be assured it is secure.

Please rate Form Pes 4012

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .