Medical Gas Maintenance Certification Examination

TO QUALIFY FOR THIS EXAMINATION

All candidates must meet the requirements of the ASSE Series 6000, Professional Qualifications Standard for Medical Gas Systems Personnel, Standard 6040.

Applicants should include the following:

  1. Successful completion of a minimum 24-hour, and
  2. Successful completion of a written and a practical examination covering all facets of the ASSE Standard 6040, and
  3. A minimum of one year of documented practical experience in the maintenance of medical gas systems

THE EXAMINATION FEE

Is One Hundred-Thirty Dollars ($130.00). This must be prepaid. Please make check or money order payable to NITC. Visa, Master Card or American Express are also accepted. For Individuals requesting to take an examination at a Prometric Center, there will be an additional sixty-dollar ($60.00) processing fee. The method of payment must be attached at the time of submission or contact NITC at (877) 457-6482 to provide credit card payment information. For NITC No-Show, Reschedule, Cancellation and Refund Policy refer to the NITC Rules and Procedures. 

To locate a Prometric Test Center, go to Prometric ProScheduler. Login information for scheduling the examination date and time will be provided via email from NITC to the email address provided above within 2 to 3 business days. Applications will not be processed until payment is received. 

Please note: Candidates may reschedule or cancel 30 days prior to the appointment with no fee. Candidates who reschedule or cancel within 5-29 days will be charged a $35 fee. Candidates rescheduling or cancelling less than 5 days prior will be charged a $50 fee and must contact NITC to obtain a new eligibility. 

All electronic devices are prohibited. No cell phones or any other types of devices that record or send data are allowed to be used during the examination. 

SPECIAL REQUESTS FOR TAKING THE EXAMINATION

Information on special accommodations can be found in Section XVII of the NITC Rules and Procedures, available for download from our web site at www.nationalitc.com.

For more information call (877) 457-6482 or e-mail maintenance@nationalitc.com.

Only complete the online application if you are testing at a Prometric Testing Center
I will be taking this exam at a Prometric Test Center.:
I have a minimum of one (1) year of documented practical experience in the maintenance of medical gas systems.:
I will have completed the required 24 hour training course prior to my test date. (Course instruction must be conducted by a Medical Gas System Instructor certified to a ASSE 6050):
I have read the Candidate Information Bulletin for NITC Medical Gas Maintenace Examination:
I am requesting the examination to the NFPA 99-2021 addition

Personal

First Name:
M.I:
Last Name:
SSN #:
Street Address:
City:
State:
Zip:
Email Address:
Cell/Other Phone:
Training Course Location:
Training Course Date:
Name of Instructor:
Local Union # (If Applicable):
Applicants NITC ID # / UA ID # (If Applicable):

List your present or most recent employer first. Attach any documentation you have that would prove that you minimum of one (1) year of documented practical experience in the maintenance of medical gas systems. Acceptable documentation: letters from employers, employment history, certification records, state license(s) and any other employment records.
(Phone numbers are required for verification.)

Experience

Must list at list 1 year of documented experience.
Employer Name #1:
City:
Phone:
From Month/Year:
To Month/Year:
Employer Name #2:
City:
Phone:
From Month/Year:
To Month/Year:
Employer Name #3:
City:
Phone:
From Month/Year:
To Month/Year:
I do solemnly swear or affirm that the above statements are true. I further realize that falsification of these statements shall be cause for disqualification. As a holder of a NITC Certification I shall agree to the following:
• I will make no false claims about the scope of my certification(s)
• I will not engage in false or misleading advertising of my NITC Certification, nor shall I utilize an NITC certification in any manner that portrays NITC unfavorably.
• I will not utilize any written documents, reports, procedures, etc., with the NITC certification mark in any manner whatsoever that may be inaccurate or false.
• I will notify NITC without delay of any changes in my capability to fulfill the requirements of this certification.
I understand that NITC reserves the right to suspend or revoke my certification should I violate these obligations. Should my certification be revoked, I agree to cease and desist any and all references to being the “holder” of an NITC Certification and shall return any certificates, including wallet sized photo identification cards to NITC.
I understand and agree that my examination results may be shared with the course instructor, training coordinator or training entity.
By affixing my signature to this application, I agree to abide by the rules and regulations of certification holders as set forth by the NITC Certification Committee.
Only Sign and Submit if you are Testing at a Prometric Center.
Signature of Applicant:
Date:
Attach all documents that apply: