self certification training matrix

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Construction Subcontractor Employee Training Matrix Contractor Name: Date: Project Name: LBNL Const. Mgr: Employee Name Ladder Scaffold User Fire Extinguisher Traffic / Flaggers Scissor or Boom Lift PPE GERT / Orientation Respiratory Program 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 I, Print Name Signature: Date: Instructions: Insert names of employees who will be working on site at LBNL in the space provided below. Place an "X" in the appropriate space to indicate that the employee has been properly trained in the corresponding subject matter, and that supporting documentation is readily available. These subject areas are those commonly encountered. Add or replace subject areas as needed. Note 1: For those columns highlighted in YELLOW, submit corresponding documentation to EH&S ([email protected]) for review & approval. Note 2: As validation, for those columns NOT in yellow, you will be required to provide documentation to EH&S as requested Use of Fall Protection Silica /Lead / Asbestos Awareness Respirator Use Medical Clearance Qualitative Respirator Fit Test Quantitative Respirator Fit Test Qualified Person- Electrical Qualified Electrical Worker Qualified Person- LOTO Competent Person- Excavation, Scaffolding Fall Protection Confined Space Crane Operations certify that the above named employees have been trained and are qualified to perform the identified tasks as indicated above.

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Training Matrix

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Page 1: Self Certification Training Matrix

Construction Subcontractor Employee Training Matrix

Contractor Name: Date:

Project Name: LBNL Const. Mgr:

Employee Name Lad

der

Sca

ffo

ld U

ser

Fir

e E

xtin

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ish

er

Use

of

Fal

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tect

ion

Tra

ffic

/ F

lag

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s

Sci

sso

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r B

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m L

ift

PP

E

GE

RT

/ O

rien

tati

on

Res

pir

ato

ry P

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alif

ied

Per

son

- L

OT

O

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

I, Print Name

Signature: Date:

Instructions: Insert names of employees who will be working on site at LBNL in the space provided below. Place an "X" in the appropriate space to indicate that the employee has been properly trained in the corresponding subject matter, and that supporting documentation is readily available. These subject areas are those commonly encountered. Add or replace subject areas as needed.

Note 1: For those columns highlighted in YELLOW, submit corresponding documentation to EH&S ([email protected]) for review & approval.

Note 2: As validation, for those columns NOT in yellow, you will be required to provide documentation to EH&S as requested ([email protected]).

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certify that the above named employees have been trained and are qualified to perform the identified tasks as indicated above.