2024 Annual Report of MA Municipal Sealersof Weights and Measures Part A

2024 Annual Report

of MA Municipal Sealers

of Weights and Measures

Part A

Reporting for the period commencing January 1, 2024, and

ending December 31, 2024

Form Submission

Pursuant to Chapter 98, Section 37, please complete this form and submit by clicking on the submit button at the bottom of this document once you have completed the form to the Division of Standards no later than end of day on January 31, 2025. Questions may be directed to the Division via email at standards.mail@mass.gov or by phone

at 617-727-3480.

Note: This form cannot be saved; any fields completed will be lost if not submitted.

*All Questions indicated with a Red Asterisk are fields requiring an answer.

A1. Annual Report ID*

The Annual Report ID is your Municipalities’ Name followed by AR24 (for example: Randolph-AR24)

Select or enter value

A2. Sealer's Last Name*

A3. Sealer's First Name*

A4. Sealer's City/Town*

City/Town that you perform sealing duties and for which you are submitting this information (one municipality only).

Select or enter value

A5. Street Address*

Business address or if none, home address

A6. City/Town*

Business City/Town or if none, home City/Town

Select or enter value

A7. State*

Business state or if none, home state

Select or enter value

A8. Zip Code*

Business zip code or if none, home zip code

A9. Business Phone

Business phone or if none, you can leave blank

Phone

A10. Cell Phone:

Should be cell phone used for Sealer duties. If no Sealer cell phone, please leave blank.

Phone

A11. Email Address*

A12. Date of Appointment as Sealer*

Length of Service as Sealer*

Select or enter value

Date of Division of Standards Certification*

A13. Are Sealer Duties full or part time duties?*

Select

How many hours do you work on Weights & Measures duties?*

Select

A14. How are you compensated:*

Select

If other, please explain

A15. Department from which Sealer operates*

Do you operate under another Department in your City/Town (DPW, Inspections, etc.)

Department Street Address*

Department City*

Select or enter value

Department Zip Code*

Sealer's Direct Supervisor's Name*

Sealer's Direct Supervisor's Title*

Sealer's Direct Supervisor's Phone*

Phone

Sealer's Direct Supervisor's Email*

Report of Certification in Additional Disciplines

As part of your initial certification, you are required to demonstrate knowledge for testing Small Capacity Scales and Gasoline Meters.

However, some sealers are responsible for testing and sealing other types of devices and are required to obtain certification in those disciplines. To ensure uniformity in testing and sealing of these devices, certification of these additional disciplines is required.

Please check the boxes below indicating what additional devices or disciplines you are testing within your jurisdiction and if you have obtained certification by attending any of the number of training seminars offered in the past years in the disciplines listed below.

A16. Do you have additional disciplines to report?*

Select or enter value

Item Pricing, Testing

Item Pricing, Certified

Pharmacy Balances, Testing

Pharmacy Balances, Certified

Price Verification P19, Testing

Price Verification P19, Certified

Small capacity >60 lb (non-vehicle), Testing

Small capacity >60 lb (non-vehicle), Certified

Heavy Capacity Vehicle Scales, Testing

Heavy Capacity Vehicle Scales, Certified

Taxi Meter, Testing

Taxi Meter, Certified

Vehicle Tank Meters, Testing

Vehicle Tank Meters, Certified

Continuing Education Credits Completed

In order to maintain your certification, all certified weights and measures officials are required to report, annually, all Continuing Education Credits (CEU) earned during the previous year. CEUs listed will be credited after verification by the Division. 3.0 CEU’s must be obtained every two years for certified officials with less than ten (10) years of service and 2.0 CEU’s for officials with more than ten (10) years of service. Failure to procure the required hours of “official” training could adversely impact your certification status.

Continuing Education Units

The following CEUs are recognized:

• Weights and Measures Association's 1-day meeting: 0.5 CEUs

• Weights and Measures Association’s 2-day meeting: 1.5 CEUs

• Division of Standards 1-day training: 0.5 CEUs

A17. Do you have any Continuing Education Units (CEUs) to report?*

Select or enter value

CEU Training Type (1)

CEU Training Date (1)

Total CEUs Earned (1)

CEU Training Type (2)

CEU Training Date (2)

Total CEUs Earned (2)

CEU Training Type (3)

CEU Training Date (3)

Total CEUs Earned (3)

Additional Continuing Education Units to Report

If you have additional CEUs than space allowed, please upload a separate summary sheet at the bottom of this form.

Deputy Sealer

A18. Is there a Deputy Sealer(s)?*

Deputy Sealer's will be listed numerically (Deputy Sealer 1, Deputy Sealer 2, etc.).

Select or enter value

Deputy Sealer 1's Last Name*

Deputy Sealer 1's First Name*

Deputy Sealer 1's Address*

Business address or if none, home address

Deputy Sealer 1's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 1's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 1's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 1's Business Phone

Phone

Deputy Sealer 1's Cell Phone

Phone

Deputy Sealer 1's Email*

Deputy Sealer 1's Date of Appointment*

Deputy Sealer 1's Length of Service*

Select or enter value

Deputy Sealer 1's Date of Division of Standards Certification*

Do you have a Deputy Sealer 2 to add?*

Select or enter value

Deputy Sealer 2's Last Name*

Deputy Sealer 2's First Name*

Deputy Sealer 2's Address*

Business address or if none, home address

Deputy Sealer 2's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 2's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 2's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 2's Business Phone

Phone

Deputy Sealer 2's Cell Phone

Phone

Deputy Sealer 2's Email*

Deputy Sealer 2's Date of Appointment*

Deputy Sealer 2's Length of Service*

Select or enter value

Deputy Sealer 2's Date of Division of Standards Certification*

Do you have a Deputy Sealer 3 to add?*

Select or enter value

Deputy Sealer 3's Last Name*

Deputy Sealer 3's First Name*

Deputy Sealer 3's Address*

Business address or if none, home address

Deputy Sealer3's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 3's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 3's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 3's Business Phone

Phone

Deputy Sealer 3's Cell Phone

Phone

Deputy Sealer 3's Email*

Deputy Sealer 3's Date of Appointment*

Deputy Sealer 3's Length of Service*

Select or enter value

Deputy Sealer 3's Date of Division of Standards Certification*

Do you have a Deputy Sealer 4 to add?*

Select or enter value

Deputy Sealer 4's Last Name*

Deputy Sealer 4's First Name*

Deputy Sealer 4's Address*

Business address or if none, home address

Deputy Sealer 4's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 4's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 4's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 4's Business Phone

Phone

Deputy Sealer 4's Cell Phone

Phone

Deputy Sealer 4's Email*

Deputy Sealer 4's Date of Appointment*

Deputy Sealer 4's Length of Service*

Select or enter value

Deputy Sealer 4's Date of Division of Standards Certification*

Do you have a Deputy Sealer 5 to add?*

Select or enter value

Deputy Sealer 5's Last Name*

Deputy Sealer 5's First Name*

Deputy Sealer 5's Address*

Business address or if none, home address

Deputy Sealer 5's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 5's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 5's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 5's Business Phone

Phone

Deputy Sealer 5's Cell Phone

Phone

Deputy Sealer 5's Email*

Deputy Sealer 5's Date of Appointment*

Deputy Sealer 5's Length of Service*

Select or enter value

Deputy Sealer 5's Date of Division of Standards Certification*

Do you have a Deputy Sealer 6 to add?*

Select or enter value

Deputy Sealer 6's Last Name*

Deputy Sealer 6's First Name*

Deputy Sealer 6's Address*

Business address or if none, home address

Deputy Sealer 6's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 6's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 6's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 6's Business Phone

Phone

Deputy Sealer 6's Cell Phone

Phone

Deputy Sealer 6's Email*

Deputy Sealer 6's Date of Appointment*

Deputy Sealer 6's Length of Service*

Select or enter value

Deputy Sealer 6's Date of Division of Standards Certification*

Do you have a Deputy Sealer 7 to add?*

Select or enter value

Deputy Sealer 7's Last Name*

Deputy Sealer 7's First Name*

Deputy Sealer 7's Address*

Business address or if none, home address

Deputy Sealer 7's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 7's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 7's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 7's Business Phone

Phone

Deputy Sealer 7's Cell Phone

Phone

Deputy Sealer 7's Email*

Deputy Sealer 7's Date of Appointment*

Deputy Sealer 7's Length of Service*

Select or enter value

Deputy Sealer 7's Date of Division of Standards Certification*

Do you have a Deputy Sealer 8 to add?*

Select or enter value

Deputy Sealer 8's Last Name

Deputy Sealer 8's First Name*

Deputy Sealer 8's Address*

Business address or if none, home address

Deputy Sealer 8's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 8's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 8's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 8's Business Phone

Phone

Deputy Sealer 8's Cell Phone

Phone

Deputy Sealer 8's Email*

Deputy Sealer 8's Date of Appointment*

Deputy Sealer 8's Length of Service*

Select or enter value

Deputy Sealer 8's Date of Division of Standards Certification*

Do you have a Deputy Sealer 9 to add?*

Select or enter value

Deputy Sealer 9's Last Name*

Deputy Sealer 9's First Name*

Deputy Sealer 9's Address*

Business address or if none, home address

Deputy Sealer 9's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 9's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 9's Zip Code

Business zip/code or if none, home zip code

Deputy Sealer 9's Business Phone

Phone

Deputy Sealer 9's Cell Phone

Phone

Deputy Sealer 9's Email*

Deputy Sealer 9's Date of Appointment*

Deputy Sealer 9's Length of Service*

Select or enter value

Deputy Sealer 9's Date of Division of Standards Certification*

Do you have a Deputy Sealer 10 to add?*

Select or enter value

Deputy Sealer 10's Last Name*

Deputy Sealer 10's First Name*

Deputy Sealer 10's Address*

Business address or if none, home address

Deputy Sealer 10's City/Town*

Business City/Town or if none, home City/Town

Select or enter value

Deputy Sealer 10's State*

Business State or if none, home State

Select or enter value

Deputy Sealer 10's Zip Code*

Business zip/code or if none, home zip code

Deputy Sealer 10's Business Phone

Phone

Deputy Sealer 10's Cell Phone

Phone

Deputy Sealer 10's Email*

Deputy Sealer 10's Date of Appointment*

Deputy Sealer 10's Length of Service*

Select or enter value

Deputy Sealer 10's Date of Division of Standards Certification*

Compliance Statement

The foregoing comprises my annual report for the period ending December 31, 2024, and is herewith submitted as required by law.

Electronically Signed*

You may electronically sign this form by typing an S-Signature (/s/ and first name then last name): Example: /S/John Smith

Date Signed*

Attachments

Please upload a current picture of your red and green inspection stickers and any addition summary sheets needed here.

File Upload

Drag and drop files here or

NOTE: if you want a copy of your responses, you MUST check the “Send me a copy of my responses” box below. If you do not check the box, you will NOT receive a copy of your submission.

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