Form EHS-42 "Hands-On Assessment Lead Inspector / Risk Assessor" - New Jersey

What Is Form EHS-42?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2014;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form EHS-42 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form EHS-42 "Hands-On Assessment Lead Inspector / Risk Assessor" - New Jersey

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New Jersey Department of Health
HANDS-ON ASSESSMENT
LEAD INSPECTOR / RISK ASSESSOR
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.
Rating
(Check one number for each)
Item
Activity
1
2
3
4
5
Inspection strategy
1. Lead-based paint inspection
Suspect locations
methods
Painting history
Sampling and inspection guidelines
2. Lead-based paint testing
Testing methodologies
procedures
Random testing procedures
Interpreting test results
3. Preparation of final inspection
Components of reports
report of test results
Recommendations
Dust sampling methodologies
4 Dust and soil clearance
sampling methodologies
Soil sampling methodologies
Categorization of condition
5. Visual inspection
Risk assessment of hazard
Components of report
6. Preparation of risk assessment
Recommendations
and final inspection report
Implementation schedule for report
Total Each Column:
Total Score (add total from each column):
Multiply total score by this number (round to nearest whole number):
X 1.25
Score:
Indicate pass or fail (must have at least 70% to pass):
Pass
Fail
Rater (print)
Agency Number
Rater Signature
Date
EHS-42
SEP 14
New Jersey Department of Health
HANDS-ON ASSESSMENT
LEAD INSPECTOR / RISK ASSESSOR
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.
Rating
(Check one number for each)
Item
Activity
1
2
3
4
5
Inspection strategy
1. Lead-based paint inspection
Suspect locations
methods
Painting history
Sampling and inspection guidelines
2. Lead-based paint testing
Testing methodologies
procedures
Random testing procedures
Interpreting test results
3. Preparation of final inspection
Components of reports
report of test results
Recommendations
Dust sampling methodologies
4 Dust and soil clearance
sampling methodologies
Soil sampling methodologies
Categorization of condition
5. Visual inspection
Risk assessment of hazard
Components of report
6. Preparation of risk assessment
Recommendations
and final inspection report
Implementation schedule for report
Total Each Column:
Total Score (add total from each column):
Multiply total score by this number (round to nearest whole number):
X 1.25
Score:
Indicate pass or fail (must have at least 70% to pass):
Pass
Fail
Rater (print)
Agency Number
Rater Signature
Date
EHS-42
SEP 14