Form 16-670 Application for Approval of Lead Training Courses - Illinois

Form 16-670 is a Illinois Department of Public Health form also known as the "Application For Approval Of Lead Training Courses". The latest edition of the form was released in February 1, 2017 and is available for digital filing.

Download a PDF version of the Form 16-670 down below or find it on Illinois Department of Public Health Forms website.

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Application for Approval of
Lead Training Courses
State of Illinois
Illinois Department of Public Health
Application for Approval of Lead Training Courses
Renewal for Approval of Lead Training Courses
All lead training course approvals expire on October 15 of each year.
Check all training courses that apply:
Worker Initial ($500)
Worker Refresher ($250)
Worker Initial – Spanish ($500)
Worker Refresher – Spanish ($250)
Worker Initial – Polish ($500)
Worker Refresher – Polish ($250)
Supervisor Initial ($500)
Supervisor Refresher ($250)
Inspector Initial ($500)
Inspector Refresher ($250)
Risk Assessor Initial ($500)
Risk Assessor Refresher ($250)
RRP Initial ($500)
RRP Refresher ($250)
Late Fee ($50) per course. Applications for renewal of all lead training course providers must be received by
September 15 of each year.
Alternative Course Fee ($100). If the training program provider is approved to conduct the standard lead course for
a specific discipline, an additional application fee is assigned for each alternative course schedule of that discipline.
*All Fees Are Non-refundable and Non-transferrable*
Training Course Provider Information
Training Course Provider Name:
Contact Person:
Street Address:
City:
State:
Zip Code:
County:
Phone:
Fax:
Email:
Website: (If applicable)
Training Manager:
Principal Instructor:
The Public Information Disclosure:
By submitting this application, the training provider authorizes the the Illinois Department of Public Health (IDPH) to publish
business or personal information on all IDPH listings. Signing this form further confirms the company’s agreement to hold
harmless and release this IDPH from any liability arising from release of the information authorized below.
I hereby certify that the information submitted is true and valid, and I understand that IDPH may deny this training course
approval for knowingly making false or fraudulent claims.
Authorized Signature:
Date:
Electronic notification forms and class rosters may be
IMPORTANT NOTICE
obtained by contacting the Illinois Lead Program at
IDPH is requesting disclosure of information that is necessary to
(217)782-5830 or dph.lead@illinois.gov
accomplish the statutory purpose as outlined under the Public
Law PA 87-175. Disclosure of this information is mandatory.
Failure to provide any information could result in denial,
revocation, or suspension of the Lead Training Course approval.
This application shall be signed and dated. Application forms are processed in the order they are received. E-mailed and faxed applications
will not be accepted. Please allow four weeks for IDPH to process the application and send the license in the mail. For additional
information you may contact the Illinois Lead Program at 217-782-3517. Mail to: Illinois Department of Public Health, Division of
Environmental Health, Illinois Lead Program, 525 W. Jefferson St., 3rd Floor, Springfield, IL 62761.
Revised 2/17
16-670
Application for Approval of
Lead Training Courses
State of Illinois
Illinois Department of Public Health
Application for Approval of Lead Training Courses
Renewal for Approval of Lead Training Courses
All lead training course approvals expire on October 15 of each year.
Check all training courses that apply:
Worker Initial ($500)
Worker Refresher ($250)
Worker Initial – Spanish ($500)
Worker Refresher – Spanish ($250)
Worker Initial – Polish ($500)
Worker Refresher – Polish ($250)
Supervisor Initial ($500)
Supervisor Refresher ($250)
Inspector Initial ($500)
Inspector Refresher ($250)
Risk Assessor Initial ($500)
Risk Assessor Refresher ($250)
RRP Initial ($500)
RRP Refresher ($250)
Late Fee ($50) per course. Applications for renewal of all lead training course providers must be received by
September 15 of each year.
Alternative Course Fee ($100). If the training program provider is approved to conduct the standard lead course for
a specific discipline, an additional application fee is assigned for each alternative course schedule of that discipline.
*All Fees Are Non-refundable and Non-transferrable*
Training Course Provider Information
Training Course Provider Name:
Contact Person:
Street Address:
City:
State:
Zip Code:
County:
Phone:
Fax:
Email:
Website: (If applicable)
Training Manager:
Principal Instructor:
The Public Information Disclosure:
By submitting this application, the training provider authorizes the the Illinois Department of Public Health (IDPH) to publish
business or personal information on all IDPH listings. Signing this form further confirms the company’s agreement to hold
harmless and release this IDPH from any liability arising from release of the information authorized below.
I hereby certify that the information submitted is true and valid, and I understand that IDPH may deny this training course
approval for knowingly making false or fraudulent claims.
Authorized Signature:
Date:
Electronic notification forms and class rosters may be
IMPORTANT NOTICE
obtained by contacting the Illinois Lead Program at
IDPH is requesting disclosure of information that is necessary to
(217)782-5830 or dph.lead@illinois.gov
accomplish the statutory purpose as outlined under the Public
Law PA 87-175. Disclosure of this information is mandatory.
Failure to provide any information could result in denial,
revocation, or suspension of the Lead Training Course approval.
This application shall be signed and dated. Application forms are processed in the order they are received. E-mailed and faxed applications
will not be accepted. Please allow four weeks for IDPH to process the application and send the license in the mail. For additional
information you may contact the Illinois Lead Program at 217-782-3517. Mail to: Illinois Department of Public Health, Division of
Environmental Health, Illinois Lead Program, 525 W. Jefferson St., 3rd Floor, Springfield, IL 62761.
Revised 2/17
16-670
Application for Approval of
Lead Training Courses
State of Illinois
Illinois Department of Public Health
Lead Training Course Approval Requirements - Illinois Lead Poisoning Prevention Code
Section 845.105
Approval Qualifications for Lead Training Course Provider. Approval for lead training courses is based on the
requirements specified in the Lead Poisoning Prevention Code Section 845.100, as revised. If the course is
disapproved, you will be contacted by letter. Application for refresher courses can be made concurrently with the
initial course. IDPH does not need additional copies of course material for the refresher course if it is the same as
the initial course, excluding copies of the refresher course agenda.
Separate approval is required for the lead abatement worker training course discipline taught in a language other
than English. The lead abatement worker training course discipline is the only discipline that will be approved to be
offered in a foreign language. If you wish to teach a course in Polish, Spanish, or any other foreign language you
must apply for and receive separate approval. In addition, you must include a signed statement that the foreign
language course content will be the same as the English language course content. If the course is not the same as
the English version then you must provide the foreign version with an English translation of the content of the
course. Submit your agendas and other hand-out materials in the foreign language. Your class list and certificates
must indicate the language other than English. Any deviation from the approved course, such as conducting
courses longer than an eight (8) hour day, shall not be approved by IDPH without prior IDPH review and approval
of such course. Separate approval is required for abbreviated or extended course. Such approval is required
before the courses are offered or held. IDPH must receive a written request with a copy of the course agenda,
times, etc. reflecting that the alternative course meets the requirements set forth in the full course. “Training
Hour” means at least 50 minutes of actual teaching, including time devoted to lecture, learning activities,
small group activities demonstration, evaluations, and/or hands-on experience.
After your course has been approved, you are required to submit the class roster by email, fax or mail showing the
names of all who passed the course, including SS #, Certificate #, dates and times of the course, instructor names
and where the course was held, to:
Illinois Department of Public Health
Division of Environmental Health, Illinois Lead Program
525 W. Jefferson St., 3rd Floor, Springfield, IL 62761
217-557-1188
Failure to provide the requested information may result in denial of your training course approval. If you have any
question, please contact the Illinois Lead Program at 217-782-3517, TTY 800-547-0466 for the hearing impaired.
Revised 2/17
16-670
Application for Approval of
Lead Training Courses
State of Illinois
Illinois Department of Public Health
Requirements for Approval of Lead Inspector Training Courses
To obtain approval for a lead inspector training course, a training program provider shall submit information to
confirm that the program provides:
1) A minimum of 24 training hours, with a minimum of eight hours devoted to hands-on activities. The course
topic requirements shall include the following [requirements ending in an asterisk (*) require lecture and
hands-on activities]:
A) Role and responsibilities of a lead inspector
B) Information on lead and the adverse health effects of lead exposure
C) Information on federal, State, and local regulations and guidance pertaining to lead-based paint and
lead-based paint activities
D) Lead-based paint inspection methods, including selection of rooms and components for sampling or
testing*
E) Paint, dust, and soil sampling methodologies*
F) Clearance standards and testing, including random sampling*
G) Preparation of the final inspection report* and
H) Record keeping
2) The one day (eight hour) Lead Inspector refresher course content shall be the same as the course content
specified in subsection (a)(1) of this Section, and any current safety practices, new laws and regulations,
and current technologies relating to lead-based paint activities. Requirements ending in an asterisk (*)
indicate areas that require refresher hands-on activities.
Requirements for Approval of Risk Assessor Training Courses
To obtain approval for a risk assessor training course, a person shall submit information to confirm that the course
provides:
1) A minimum of 16 training hours, with a minimum of four hours devoted to hands-on activities. The course
topic requirements shall include the following [requirements ending in an asterisk (*) require lecture and
hands-on activities]:
A) Assurance to IDPH that a lead inspector training course certificate of completion is required of each
applicant as a prerequisite for risk assessor training course attendance
B) Role and responsibilities of the risk assessor
C) Collection of necessary building information required to perform a lead risk assessment
D) Sources of environmental lead contamination (paint, surface dust and soil, water, air, packaging and
food)
E) Visual inspection procedures for the purpose of identifying potential sources of lead-based paint
hazards*
F) Lead hazard screening protocol
G) Sampling for sources of lead exposure*
H) Interpretation of lead-based paint and other lead sampling results, including all applicable State and
federal guidance pertaining to lead-based paint hazards (i.e., federal statutes and regulations)*
I) Development of hazard-control options, the role of interim controls, and operations and maintenance
activities to reduce lead-based paint hazards and
J) Preparation of a final lead risk assessment report.
2) The one day (eight hour) lead risk assessor refresher course content shall be the same as the course
content specified in subsection (b) (1) of this Section, and any current safety practices, new laws and
regulations, and current technologies relating to lead-based paint activities. Requirements ending in an
asterisk (*) indicate areas that require refresher hands-on activities.
Revised 2/17
16-670
Application for Approval of
Lead Training Courses
State of Illinois
Illinois Department of Public Health
Requirements for Approval of Lead Worker Training Courses
To obtain approval for a lead worker training course, a person shall submit information to confirm that the course
provides:
1) A minimum of 24 training hours, with a minimum of eight hours devoted to hands-on activities. The course
topic requirements shall include the following [requirements ending in an asterisk (*) require lecture and
hands-on activities]:
A) Role and responsibilities of a lead worker
B) Information on lead and the adverse health effects of lead exposure
C) Information on federal, State and local regulations
D) Lead-based paint hazard recognition and control*
E) Lead-based paint abatement and lead-based paint hazard reduction methods, including restricted
practices*
F) Interior dust abatement methods/cleanup*
G) Soil and exterior dust abatement methods* and
H) Respiratory protection, including review of the OSHA Lead Standard.
2) The one day (eight hour) lead worker refresher course content shall be the same as the course content
specified in subsection (c)(1) of this Section, and any current safety practices, new laws and regulations,
and current technologies relating to lead-based paint activities. Requirements ending in an asterisk (*)
indicate areas that require refresher hands-on activities.
Requirements for Approval of Supervisor Training Courses.
To obtain approval for a lead supervisor training course, a person shall submit information to confirm that the
course provides:
1) A minimum of 32 training hours, with a minimum of eight hours devoted to hands-on activities. The course
topic requirements shall include the following [requirements ending in an asterisk (*) require lecture and
hands-on activities]:
A) Role and responsibilities of a lead supervisor
B) Information on lead and its adverse health effects
C) Information on federal, State and local regulations and guidance that pertain to lead-based abatement
D) Liability and insurance issues relating to lead-based abatement
E) Lead risk assessment and inspection report interpretation*
F) Development and implementation of an occupant protection plan and abatement report
G) Lead-based paint hazard recognition and control*
H) Lead-based paint abatement and lead-based paint hazard reduction methods, including restricted
practices*
I) Interior dust abatement/cleanup*
J) Soil and exterior dust abatement*
K) Clearance standards and testing
L) Cleanup and waste disposal
M) Record keeping
N) Integration of lead-based paint abatement methods with modernization and rehabilitation projects for
large scale abatement projects and
O) Respiratory protection, including review of the OSHA Lead Standard
Revised 2/17
16-670
Application for Approval of
Lead Training Courses
State of Illinois
Illinois Department of Public Health
2) The one day (eight hour) lead supervisor refresher course content shall be the same of the course content
specified in subsection (d)91) of this Section, and any current safety practices, new laws and regulations,
and current technologies relating to lead-based paint activities. Requirements ending in an asterisk (*)
indicate areas that require refresher hands-on activities.
Requirements for Approval of RRP Training Courses
To obtain approval for an RRP training course, a person shall:
1) Submit certification showing that the course has been approved and certified by the USEPA to train RRP.
2) Submit notification to IDPH seven days prior to holding a RRP training course.
3) Submit a full class roster to IDPH within seven days of the class’s conclusion.
Approval of Lead Alternative Course Schedules:
1) An Alternative Course Schedule is defined as:
A) Any training agenda that includes a training day of more than eight hours, but fewer than 12 hours.
Courses that consist of more than 12 hours of training per day will not be approved by IDPH (Note: a
training hour consists of 50 minutes of training time)
B) Any training agenda that includes a training day of fewer than eight hours
C) Any training agenda that includes more training days than required by this Part
D) Any training agenda that includes fewer training days than required by this Part
E) Any altered training course that may be offered in addition to the standard lead training course (an
example is a training course provider offering the standard three-day (eight hours per day) lead worker
course and also a four-day lead worker course) or
F) Any combined training course that covers more than one training course discipline.
2) Application for Alternative Course Schedules shall be made in accordance with the appropriate discipline
requirements set forth in this Section.
Approval of Foreign Language Courses: The lead worker training course discipline is the only discipline that will be
approved to be offered in a foreign language. All other lead training course disciplines shall be offered in English.
Foreign language lead worker disciplines shall meet all of the requirements specified in subsection (c) of this
Section. All foreign language course manuals, exams and other course material required by this Section shall be
provided in both the language in which the course is to be offered and English.
Revised 2/17
16-670

Download Form 16-670 Application for Approval of Lead Training Courses - Illinois

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