New Jersey Department of Health

Hands-on Assessment

Lead Worker - COMMERCIAL Buildings AND SUPERSTRUCTURES

Student Name

Date

For the hands-on assessment of the training course, instructors shall rate student performance on a scale of 1-5 (5 being the best). During the hands-on assessment, students shall be required to demonstrate competency in the following areas. Items/procedures must be developed to test each activity. These items/procedures must be submitted to the Department for approval prior to implementation.
Item	Activity	Rating

(Check one number for each)
1	2	3	4	5
1.	Hazard recognition and control	Site characterization
Preparation of worksite
Exposure measurements
Material identification
Safety and health plan
Medical surveillance
Engineering and work practices
2.	Personal protective Equipment	Donning respirators
Positive and negative fit checks of respirators
Care and cleaning of respirators
Suiting up and disposal of clothing
Personal decontamination
Hygiene practices
3.	Lead-based paint abatement and hazard reduction methods	Scraping
Chemical removal
Heat removal
4.	Interior dust abatement methods/clean-up or lead hazard reduction	Sequence of removal and cleaning
HEPA vacuuming
Wet washing (with high phosphate detergent)
5.	Soil and exterior dust abatement methods or lead hazard reduction	Sequence of removal
6.	Waste disposal	Proper bagging
Proper disposal of various types of materials
Classifying waste
Total Each Column:
Total Score (add total from each column):
Multiply total score by this number (round to nearest whole number):	X .87
Score:
Indicate pass or fail (must have at least 70% to pass):	Pass Fail
Rater (print)

Agency Number

Rater Signature	Date

EHS-41

SEP 14

EHS-41 Hands on assessment, lead worker, commercial buildings and superstructures

ewhite

2014-08-25

njdoh