Sample Screening Questionnaire for Qualifying the Industrial Hygienist

7. SAMPLE SCREENING QUESTIONNAIRE FOR QUALIFYING THE INDUSTRIAL HYGIENIST

INDUSTRIAL HYGIENIST QUALIFICATION QUESTIONNAIRE

1. Will the Project Manager be an Industrial Hygienist who is certified

by the American Board of Industrial Hygiene or

EPA-AHERA? ______________________.

2. What percentage of the project tasks will be done by various

personnel?

PERSONNEL ( %TIME )

Project Supervisor

Project

Air Sampling

Other

_________________________________________________________________

Project Mgmt.

________ _________________ _________

Bldg. Survey and Assessment

________ _________________ _________

Spec. Dev. and Review

________ _________________ _________

Contractor Qualification

________ _________________ _________

Abate Monitor

________ _________________ _________

Pre-

________ _________________ _________

During-

________ _________________ _________

Post-

________ _________________ _________

Final Rep. Review

________ _________________ _________

3. What specific experience in asbestos does the consultant have?

1.

2.

3.

4.

__________________________________________________________________

Client Name

_________

Phone Number

_________

Date

_________

Duration

_________

Involvement

_________

Personnel

_________

4. What formal asbestos abatement training programs have been attended by

the persons assigned to the project? (OSHA/EPA/NIOSH, Seminars, etc.)

What were the dates of attendance?

5. Is the consultant accredited/certified by the state or other

jurisdiction for asbestos work (where required): Dates of certification

and number?

6. Are all personnel assigned to the project on the staff of the consultant

or will subcontractors be used? Explain:

7. Is the laboratory to be used for analysis of air samples accredited by

the American Industrial Hygiene Association?

What is the lab

accreditation number?

8. Is the laboratory to be used for bulk samples a participant in the EPA

NIST/NVLAP? Participant number?

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