Institute for Tribal Environmental Professionals
PO Box 15004
Flagstaff, Arizona 86011
http://www7.nau.edu/itep/main/
Tribal Waste and Response Assistance Program
Dear Tribal Environmental Professional:
The Institute for Tribal Environmental Professionals (ITEP), in collaboration with the U.S. EPA Environmental
Response Team, will be offering a 40 Hour Hazardous Waste Operations and Emergency Response
(HAZWOPER) training course in Las Vegas, Nevada. The dates for the course are February 22-26, 2016. All
course activities will be held at the Tribal Air Monitor Support (TAMS) Center in Las Vegas. This course is
designed specifically for employees of federally-recognized tribes with environmental and emergency
response programs, who require training in the investigation and remediation of uncontrolled hazardous
waste sites and, to a lesser extent, response activities related to accidents involving hazardous materials.
There is no tuition or fee for the course. ITEP will pay lodging expenses (room and taxes only) and reimburse
per diem for up to 20 eligible participants. ITEP, however, cannot pay or reimburse transportation expenses
for participants.
Please review the following items to know what the requirements and expectations are for the course:
 Course Description sheet
 Course Application
 ITEP Cancellation Policy
 Medical Requirement sheet (for respirator)
 ITEP Medical Clearance for Respirator Use Form
If you are interested in attending the course, please complete the application and submit it with all required
documents. Please note that a medical clearance is required to attend the course; see ITEP Medical
Requirement sheet for more information. Space in this course is very limited, so please be sure to get your
application in as soon as possible. Deadline to submit your paperwork is February 5, 2016.
Should you have any questions or require additional information, please feel free to contact me. My phone
number is (928) 523-2082 and email address is roberta.tohannie@nau.edu. Thank you.
Regards,
Roberta Tohannie
Program Coordinator, Sr.
Institute for Tribal Environmental Professionals
Tribal Waste and Response Assistance Program
40 Hour HAZWOPER Training Course
Las Vegas, Nevada
February 22-26, 2016
COURSE DESCRIPTION
This 5-day course instructs participants to recognize, evaluate, and remediate an uncontrolled hazardous
waste site. The course provides basic information needed to meet the 40 Hour training requirements of 29
CFR 1910.120 (e)(3)(i) Hazardous Waste Operations and Emergency Response (HAZWOPER). Participants
become more knowledgeable in hazardous waste operations, health and safety, and team functions.
After completing the course, participants will be able to:
 identify methods and procedures for recognizing, evaluating, and controlling hazardous substances;
 identify concepts, principles, and guidelines to properly protect site or response personnel;
 discuss regulations and action levels to ensure health and safety of the workers;
 discuss fundamentals needed to develop organizational structure and standard operating procedures;
 select and use dermal and respiratory protective equipment; and
 demonstrate the use, calibration, and limitations of field monitoring instruments.
Training Medical Requirements:
 This course includes a full dress-out with respirators, therefore, a medical evaluation in accordance
with the Respiratory Protection Standard, 29 CFR 1910.134, is necessary in order to attend the course.
 See course medical requirement sheet for more information.
Participant Information:
 Classes will begin at 8:00 a.m. and run until 5:30 p.m., Monday through Thursday. The course ends at
1:30 pm on Friday.
 Lodging is available for ITEP-sponsored participants for the nights of February 21 (Sunday) to February
25 (Thursday). ITEP has selected a hotel near the training site and will arrange lodging reservations
for participants.
 The training course will be held at the TAMS Center, not at designated hotel. Van transportation to
and from the TAMS Center will be available, but seating may be limited.
 To receive a course certificate, 100% attendance is mandatory.
Registration and Confirmation:
 To register for the course, a completed application with medical documentation must be sent to ITEP
by February 5, 2016.
 A notice of confirmation, course agenda, and Fact Sheet will be sent to those who are selected to
participate in the course. The Fact Sheet will contain information of training and lodging location, as
well as other course details.
Institute for Tribal Environmental Professionals
40-Hr HAZWOPER
TENTATIVE AGENDA
Day One:
•
•
•
•
ITEP Overview
Orientation/Introduction
Introduction to 29 CFR 1910.120 (Legal Overview)
Hazards, Toxicology and Exposure Guidelines
Day Two:
•
•
•
PPE Overview; Donning and Doffing
Air Monitoring
Level B and C dress out
Day Three:
•
•
•
•
PPE Donning and Doffing (Level A, B, and C)
Site Entry and Reconnaissance
Decontamination
ICS
Day Four:
•
•
PPE Donning and Doffing
Site exercises and drills
Day Five:
•
•
•
•
Other safety hazards
WMD
Exam
Course closing
COURSE APPLICATION
40 Hour HAZWOPER
February 22-26, 2016
Las Vegas, Nevada
Deadline: February 5, 2016
(Please enter your text in the grey text box; there are no character limits)
Name
Title
Tribe/Organization
Mailing Address
Fax_
Phone
Email
(Note: Since most of the communications from our office will be conducted via email, please make certain you provide an
adequate email address on the application.)
Explain your present work duties and why you are interested in this course:
Do you need financial assistance with lodging at designated hotel?
If Yes, please select the dates you would need lodging assistance.
Sunday (Feb 21) ___
Monday (Feb 22) ___
Tuesday (Feb 23) ___
Wednesday (Feb 24) ___
Yes
No
Thursday (Feb 25) ___
I,
(Applicant) agree to participate in all aspects of the training, including full dress-out (with applicable
respirators) and field activities, as well as abide by course policies on travel, cancellation, and dismissal.
Participant’s Signature:___________________________________________________________________
The signature of your immediate supervisor is required to approve your application for this training course and to
accept the terms of ITEP’s policy on cancellations and participant expectations, if selected.
Supervisor’s Name:
Supervisor’s Signature:_________________________________
Please send completed application and additional documents to: Roberta Tohannie (ITEP)
Email: roberta.tohannie@nau.edu
Fax Number: 928-523-1266
Institute for Tribal Environmental Professionals
PO Box 15004
Flagstaff, Arizona 86011
http://www7.nau.edu/itep/main/
COURSE TRAVEL AND CANCELLATION POLICY
IMPORTANT! By confirming your attendance for any ITEP training course, you accept the
following policy on course travel and cancellations. These policies have been established to
ensure the prudent use of federal funds for our training courses, which will allow more tribal
participants to benefit from our training.
I. Transportation Arrangements
 Transportation arrangements are the responsibility of the traveler.
 Please do not make transportation arrangements until notification of selection
to attend a course has been received/verified.
II. Cancellations
 Hotel arrangements are made in advance by ITEP through a legally-binding
contract. If you must cancel your hotel room, contact ITEP directly; do not contact the
hotel.
 You must notify ITEP at least 72 hours prior to your scheduled arrival date, otherwise,
your tribe will be billed for any lodging costs incurred.
 Excessive cancellations or outstanding payment due to ITEP will jeopardize
your eligibility for future trainings.
40-Hr HAZWOPER Course
MEDICAL REQUIREMENT
The 40-Hr HAZWOPER course instructs participants to recognize, evaluate, and remediate an uncontrolled hazardous waste site. The
course provides basic information needed to meet the 40 Hour training requirements of 29 CFR 1910.120 (e)(3)(i) Hazardous Waste
Operations and Emergency Response (HAZWOPER). Participants become more knowledgeable in hazardous waste operations, health
and safety, and team functions.
Medical Requirement: The course includes a full dress-out with respirators (full-face and SCBA), therefore, a medical
evaluation in accordance with the Respiratory Protection Standard, 29 CFR 1910.134, is necessary in order to attend
the course. Each applicant must include one of the following with the application:
1) A copy of a medical certificate with evaluation results, or a physician’s statement that clearly states that a medical
evaluation has been completed within the last 12 months and that the applicant is medically able to wear
respiratory protection equipment. OR
2) ITEP Medical Clearance for Respirator Use form signed by a direct supervisor who can confirm a medical evaluation
had been performed within the last 12 months and that confirmation of the evaluation was made available to
supervisor. OR
3) ITEP Medical Clearance for Respirator Use form completed and signed by a Licensed Health Care
Professional/Provider (LHCP).
If a medical evaluation has not been conducted within the last 12 months, then applicant must complete the OSHA
Respirator Medical Evaluation Questionnaire and consult with a LHCP or occupational nurse for further review. If the
LHCP or nurse recommends a follow-up medical evaluation, then applicant must schedule the evaluation/exam and
provide results to ITEP.
Here is the link to download the OSHA Respirator Medical Evaluation Questionnaire:
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9783
Medical Evaluation: Applicant can provide a medical certificate or statement with results from one of the following
procedures or exams below to meet the requirement:



Health Physical exam
Pulmonary Function Test (PFT)
Chest x-rays at physician’s discretion
Self Assessment for Using Respirators:
Type of respirator used: N95, N100, Air-Purifying (PAPR), Air-Purifying (Half/Full Face), Supplied-air, SCBA
Frequency of use: Daily, Weekly, Monthly, Annually
Duration of use: < 15 min
> 15 min
> 2 hrs
Variable
Physical demands while wearing respirator: Light, Moderate, Heavy
Temperature during use: (heat, etc.): < 0˚
0-25˚
> 25˚
Variable
Other protective equipment worn: Hard hat, safety glasses, boots, gloves, etc.
Work conditions: Hazardous environments/materials, confined space, emergency escape, etc.
Types of Respirators: (Reference)
If interested, review the various types of respirators at the U.S. Department of Health and Human Services – Radiation
Emergency Medical Management. http://www.remm.nlm.gov/respiratory_ppe.htm#apr
To complete the registration process, submit the following to Roberta Tohannie, ITEP:
 Course Application
 Medical Clearance through ONE of the processes described above.
DO NOT submit the OSHA Respirator Medical Evaluation Questionnaire with the application.
Institute for Tribal Environmental Professionals
MEDICAL CLEARANCE FOR RESPIRATOR USE FORM
This form is to be filled out by a licensed health care professional/provider or direct supervisor.
Name:
D.O.B.
SSN:
Phone #:
Employer:
City:
ST:
Department:
Job Title:
Supervisor Name:
Supervisor Phone #:
TO BE COMPLETED BY THE EXAMINER/REVIEWER:
The mandatory questionnaire has been reviewed, and the employee has been found to be physically able to use a respirator.
This employee has been found to be physically able to use the following types of respirators (check each that applies):
___ Single use, filter mask (four attachment points)
___ Full-faced powered cartridge-type (PAPR)
___ Half-faced cartridge-type, negative pressure
___ Self-contained breathing apparatus (SCBA)
___ Full-faced cartridge-type respirator, negative pressure
___ Hood/helmet powered cartridge-type (PAPR)
___ Half-faced powered cartridge-type (PAPR)
___ Half-faced/Full-faced/Hood/Helmet (NOT positive pressure)
Restrictions / Limitations (if any) when wearing a respirator:
___ The mandatory questionnaire has been reviewed and this employee has been found to be physically NOT able to use a
respirator.
___ There is insufficient information to make a determination at this time.
The respirator clearance expires:
___ 1
(If not marked, clearance expires in 1 year.)
___ 2
___ 3
years from the date below.
Reviewer’s Name:___________________________ Reviewer’s Signature:___________________________
Name of Medical Facility:___________________________________________
City:____________________
Date:_________
ST:__________
SUPERVISOR CLEARANCE
I can confirm that the employee named above has completed a medical evaluation pursuant to the OSHA Respiratory
Protection Standard, 29 CFR 1910.134 within the last 12 months, and that employee is physically fit to wear respirators.
Name of supervisor:
Submit completed form to: Roberta Tohannie, ITEP
Signature:
EM: roberta.tohannie@nau.edu
Institute for Tribal Environmental Professionals
NAU Box 15004
Date:
PH: 928-523-2082
Flagstaff, AZ 86011
FAX: 928-523-82