Recertification Journal

LEAN SIX SIGMA BLACK BELT

Name:

Current Certification #:

AALSSC Recertification

Recertification Units by Category200 RU Program (Black Belt)

Date Initially Certified:

Recertification Submission Window: to

Year 1 2.5 yrsYear 2 Year 3 3 yrs

Submission Window

I have a two projects documented

TOTAL:

CommentsMaximum RUs allowed Total RUs claimedDir. of Certification

initials

Employment

Professional Development

Instructor

Student

Proctoring

Writing

Examiner

AALSSCAmerican Association for Lean Six Sigma Certification

Statement: I attest that all the information included in this journal is true and correct

Signature: Date:

Name to appear on Certificate:

This is a name change(Please use all Caps and print clearly - Ex. TOMAS WILLIAMS JR.)

Mailing Address:

EMPLOYMENT

RU Full-time RU Part-time Category Maximum

3 RUs/Month Or

36 RUs per year

1.5 RUs/Month Or

18 RUs per year108 RUs

Employment Log

• Full-Time employment means you were considered by the company as a full time employee in any position (does NOT have to bequality related)• Part-Time employment RUs can be claim for any month were you were employed for at least one day in that month

Employer: Dates Employed

Job Title:

Person who can validate (name & phone) RUs Claimed

Email Address:

Employer: Dates Employed

Job Title:

Person who can validate (name & phone) RUs Claimed

Employment Log

Employer: Dates Employed

Job Title:

Person who can validate (name & phone) RUs Claimed

PROFESSIONAL DEVELOPMENT

• RUs are earned by attending conferences, seminars, workshops, webinars, meetings at professional organizations where trainingis given, or any other organized professional development training - this includes ALL topics, not just quality related• For accredited college and CEU courses please claim under "Student" category on page 9.

Professional Development Log

Employer: Dates Employed

Job Title:

Person who can validate (name & phone) RUs Claimed

RUs

1.5 RU/ per hour

Category Maximum

100 RUs

Event Date Location Event Provider Topic RUs

INSTRUCTOR

RU Credit Category Maximum

College 10 RUs per semester hour

100 RUsNon - College 5 RUs per CEU

Class/Workshop 2 RUs per hour instruction

• Any course taught that awards college credits or continuing education units (CEU)• Any class or workshop where you were the primary instructor• Courses taught at your place of work and part of your job does NOT count (part of employment)

Instructor Log

STUDENT

RU Credit Category Maximum

College Credits 7 RUs per semester hour100 RUs

Continuing Education 5 RUs per CEU

Educational institution or Local/organization

Course title Dates Hours RUs

• This category covers any college accredited course and courses that award CEUs• For attendance to all other courses claim under professional development• Courses do not have to apply to Lean Six Sigma, can be any field of study• On-Line accredited and CEU courses are included in this category

Student Log

WRITING

Category Maximum

100 RUs

• This category awards RUs for writing and publishing - to include authoring or co-authoring a book, being published in a magazineor journal, writing an online article that's published on website (Websitecannot be controlled by you)• Blog articles for websites

Writing or Getting Published

Published Book: 50 RUs

Published Article: 3 RUs

Published Blog/online: 1 RUs

Institution Name

Instructor Name

CourseTitle & Credits

Course Dates RUs

Title of work(Book, Article, Blog)

DatePublished

PublisherWebsite

RUs Claimed

Writing Log

EXAM PROCTORING

Exam Proctoring RU Credits Category Maximum

Green Belt - 5 RUs 45 RUs

Black Belt – 7.5 RUs

• Coordinate location and proctor exam for AALSSC certifications only

Date Location Exam RUs Claimed

Proctoring Log

EXAMINAR CERTIFICATION

Examinar Certification RU Credits Category Maximum

Becoming a Certified examiner - 25 RUs 75 RUs

Conduct Inspection - 15 RUs

• RUs awarded for getting certified as an examiner for quality related awards or designations. (Ex. Baldrige award, ISO certification,Shingo Award, Deming award, etc)• RUs awarded by being a team member and performing quality inspection of a company/organization

Certifying Organization or

Company Inspected

Certification or Inspection

Date(s)Point of Contact who

can Verify(reference)

RUs Claimed

Examiner Log

Black Belt Project #1

Title:

Company/organization:

Inclusive dates:

Your role:

Person who can validate your involvement:

Name:

Title:

Contact information:

Briefly describe project: (what was the problem/objective, how did it proceed, etc.)

Results:

Additional comments:

LSS tools used: (list what tools/methods you used. Ex. Value stream map, Pareto chart, etc.)

Black Belt Project #2

Title:

Company/organization:

Inclusive dates:

Your role:

Person who can validate your involvement:

Name:

Title:

Contact information:

Briefly describe project: (what was the problem/objective, how did it proceed, etc.)

Results:

Additional comments:

LSS tools used: (list what tools/methods you used. Ex. Value stream map, Pareto chart, etc.)

3) Please provide any comments, concerns, recommendations or ideas for AALSSC

"Your Road to Success"

AALSSCAmerican Association for Lean Six Sigma Certification

Checklist:

Journal documenting 200 RUs or more Two documented projects/events

Within your recertification window Signed

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