New Jersey Department of Health

Consumer, Environmental and Occupational Health Service

P.O. Box 372

Trenton, NJ 08625-0372

Required Information for New Jersey Certification of Lead Training Course

Lead Training Course Proposal Checklist

Please provide all information requested in this checklist, and include it with your completed application. Send to the above address with all required attachments.

Name of Training Agency

Date

Course Type (Check no more than one initial and corresponding refresher):

Housing/Public Buildings	Commercial Buildings/Superstructures

Initial Refresher	Initial Refresher

Worker	Worker

Supervisor	Supervisor

Inspector/Risk Assessor

Planner/Project Designer
To assure your application is complete and to expedite the review process, the following information must be submitted as required by N.J.A.C. 8:62-4.
8:62-4.3(a)1 and 2

Completed "Lead Training Agency Certification Application".
8:62-4.3(a)3

Statement signed by the training manager that clearly details how the course meets the minimum requirements outlined in N.J.A.C. 8:62-4.2 (refer to “Minimum Course Requirements”).
8:62-4.3(a)4

Brief description of course location (including dimensions):
Projected course fees:	$____________________
8:62-4.3(a)5

Provide a detailed outline of course curricula as set forth at N.J.A.C. 8:62-4.6 through 12 which details the schedule for each day of the course. Refer to appropriate NJDOH course outline for topics and suggested time allotments for each discipline.
8:62-4.3(a)6

Attach a description of the interactive/participatory teaching methods as defined at N.J.A.C. 8:62-2 (see definition below) which will be employed to present each topic.

Note: the definition of “Interactive/Participatory Teaching Methods” is as follows: Instruction which consists of active participation of the trainees, such as, brainstorming, hands-on training, demonstration and practice, small group problem solving, discussions, risk mapping, field visits, walk-throughs, problem posing, group work assignments, question-and-answer periods, and role-playing sessions. Lecture is not considered an interactive/participatory teaching method.
8:62-4.3(a)7

Attach a copy of all written materials to be distributed as part of the training course.
8:62-4.3(a)8

Include evidence demonstrating that your agency has employed a training manager and has employed or contracted to employ a minimum of three instructors, either on a full-time or part-time basis to satisfy the requirements as set forth at N.J.A.C. 8:62-4.5 (refer to “Lead Instructor/Training Manager Application).

You must Include a completed “Lead Instructor/Training Manager Application” for the training manager and each instructor. Resumes, transcripts, diplomas and professional certifications describing specialized training and education and/or prior experience shall be submitted as documentation of compliance with the instructor criteria. All resumes must include the length of time the individual has held jobs, certifications, etc.
Refer to “Facility Inspection Worksheet” to assist you in completing the following sections. That Worksheet will be used during the pre-operational inspection of your facility. You can use it as guidance in determining the quantity of items to be maintained.
8:62-4.3(a)9

List the types, brand names and quantities of respirators to be used to demonstrate a fit test:
Type
Brand Name
Quantity
8:62-4.3(a)10

List Description/Type and Quantity of protective clothing to be used during hands-on training and demonstration (use an additional sheet if necessary):
Description
Quantity
Description
Quantity
8:62-4.3(a)11

List Description and Quantity of the materials to be used for hands-on training including, but not limited to, hand tools, ladders, scaffolding, plastic sheeting, other construction equipment, air filtration units, water spray devices, decontamination facilities, simulated lead material and, where appropriate, attach Material Safety Data Sheets. (Use an additional sheet of paper if necessary):
Description
Quantity
Description
Quantity
8:62-4.3(a)12

Attach a detailed description of the of the training course site, which includes a diagram of the classroom with layout, dimensions, and the address of the training location(s) (include both lecture and hands-on sites). Indicate what the site will be used for (i.e., lecture or hands-on).

Describe the lecture facility's seating provisions (tables or desks are mandatory):
8:62-4.3(a)13

Attach a detailed description of the procedures for conducting the assessment of the hands-on skills.
8:62-4.3(a)14

Attach a statement explaining any restrictions on attendance, such as English only or other language to be used.
8:62-4.3(a)15

For non-English courses, all training course materials, examinations and related course literature must be translated into the language of the course. A copy of the translated materials with written assurance that the translation is accurate and valid must be included. Note: only the worker courses can be taught in a foreign language.
8:62-4.3(a)16

Indicate your instructor-to-student ratio for hands-on training: ____________________

Note: Minimum permissible ratio shall be no greater than 10 students to one instructor.
8:62-4.3(a)17

Attach a copy of the written examination(s) to be administered to the trainees by the training agency.

Note: Must include procedures used for validation of examination and performance results of data analysis.
8:62-4.3(a)18

Must provide evidence that a no-smoking policy will be established, maintained and enforced during all aspects of the training.
8:62-4.3(a)19

Must provide evidence of a quality control plan which, at a minimum, includes the following:

1.	Procedures for periodic revision of training materials to reflect innovations in the field

Procedures for annual review of instructor competency

Procedures for administering the course examination to ensure the validity and integrity of the examination

Procedures for administering the hands-on skills assessment

5.	Procedures for ensuring the adequacy of facilities and equipment
All materials submitted as part of the application must be typewritten or machine printed. The applicant shall be required to successfully pass a pre-commencement inspection of the training facility(ies) conducted by representatives of the Department. The applicant shall notify the Department immediately and in writing of any change(s) in the application information occurring either prior to or after the issuance of certification.
Name of Person Completing This Form (Print):

Title

Signature	Date

LEAD TRAINING COURSE PROPOSAL CHECKLIST

(Continued)

EHS-38

JUL 12	Page 3 of 3 Pages.

JUL 12	Page 1 of 3 Pages.

EHS-38, Lead Training Course Proposal Checklist

EHS-38, lead, training, course, proposal, checklist, indoor environments program, EHS

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2011-04-13

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