A01 __Y __N Is the employee/guest working at LBNL on the main site, Donner, Calvin, 903, 934, 936 or 938 (not just on campus) for more that 30 days?

Required: EHS0010 INTRODUCTION TO EH&S AT LBL

EHS0392 HAZARD COMMUNICATION EMPLOYEE TRAINING

Recommended: EHS0135 EARTHQUAKE SAFETY

EHS0405 GENERAL EMPLOYEE RADIATION TRAINING

A02 __Y __N Was the employee/guest hired before January 1982, or is s/he a rehired retiree, who originally began work at LBNL before that date?

A03 __Y __N Does the employee/guest use a computer for more than an average of 4 hours/day?

Recommended: EHS0060 ERGONOMICS FOR COMPUTER USERS

A04 __Y __N Does the employee/guest routinely enter posted "Controlled Areas" which are designated for radiation protection, but is NOT a radiation worker?

Required: EHS0405 GENERAL EMPLOYEE RADIATION TRAINING

EHS0406 GERT REFRESHER *

B01 __Y __N Is the employee/guest a division Environment, Safety, and Health Coordinator?

Recommended: EHS0060 ERGONOMICS FOR COMPUTER USERS

EHS0067 OFFICE ERGONOMICS EVALUATORS TRAINING

EHS0261 ELECTRICAL SELF-ASSESSMENT TRAINING

EHS0348 CHEMICAL HYGIENE/SAFETY TRAINING

EHS0604 HAZARDOUS WASTE GENERATOR TRAINING

Recommended: EHS0261 ELECTRICAL SELF-ASSESSMENT TRAINING

OAA0802 SELF ASSESSMENT INSPECTOR TRAINING

B03 __Y __N Is the employee/guest a Division Director or a Division designee for occurrence reporting?

Required: EHS0800 OCCURRENCE REPORTING AND PROCESSING

B04 __Y __N Is the employee/guest a building manager or a member of the building emergency team?

Required: EHS0116 FIRST AID-4HR-3YR CERTIFICATION

EHS0123 CPR-3HR-2YR CERTIFICATION

EHS0154 EMERGENCY TEAM TRAINING

EHS0530 FIRE EXTINGUISHER SAFETY

Recommended: EHS0135 EARTHQUAKE SAFETY

B05 __Y __N Is the employee/guest a member of the Lab-wide Emergency Command Center Team?

Required: ECC0002 ECC ORIENTATION TRAINING

B06 __Y __N Does the employee/guest work in any environment other than an office, and/or directly supervise those who do?

*********** If no, please skip to the required signatures at the end and sign.
If yes, continue filling out the questionnaire.

C01 __Y __N Does the employee/guest work with unsealed radioactive material, sealed sources, operate an x-ray machine, or work at the 88" Cyclotron? (If no, skip to next section.)

C02 __Y __N Does the employee/guest work with unsealed radioactive material?

Required: EHS0400 RADIATION PROTECTION-FUNDAMENTALS

EHS0432 RADIATION PROTECTION - LAB SAFETY

C03 __Y __N Does the employee/guest work with sealed sources?

Required: EHS0400 RADIATION PROTECTION-FUNDAMENTALS

EHS0438 SEALED RADIOACTIVE SOURCE TRAINING

C04 __Y __N Does the employee/guest work at the 88" Cyclotron?

Required: EHS0400 RADIATION PROTECTION-FUNDAMENTALS

EHS0439 RAD PROTECTION-ACCELERATOR BEAMLINE

C05 __Y __N Does the employee/guest generate radioactive and/or mixed waste that is stored in a designated and posted Satellite Accumulation Area (SAA)?

Required: EHS0604 HAZARDOUS WASTE GENERATOR TRAINING

EHS0622 RADIOACTIVE AND MIXED WASTE GENERATOR

C06 __Y __N Does the employee/guest operate an x-ray machine, e.g., diffraction unit cabinet x-ray machine?

Required: EHS0410 X-RAY MACHINE SAFETY

D01 __Y __N Does the employee/guest handle/use hazardous chemicals (e.g., corrosive, flammable, reactive, toxic) or routinely work where these are present?

Required: EHS0348 CHEMICAL HYGIENE/SAFETY TRAINING

D02 __Y __N Does the employee/guest generate hazardous waste that is stored in a posted Satellite Accumulation Area(SAA) or Waste Accumulation Area(WAA)?

Required: EHS0604 HAZARDOUS WASTE GENERATOR TRAINING

E01 __Y __N Does the employee/guest use, or work on/with pressure systems involving compressed gases(EXCLUDING HOUSE AIR), vacuum systems, and/or cryogenics? (If no, skip to next section.)

E02 __Y __N Does the employee/guest use compressed gases, up to 150 psi, that include components such as regulators, valves, tubing, or gauges (NO VESSELS)?

Required: EHS0231 COMPRESSED GASES

E03 __Y __N Does the employee/guest use pressure vessels, compressed gas systems > 150 psi, or pressure systems with liquid > 1500 psi?

Required: EHS0230 PRESSURE SAFETY ORIENTATION

E04 __Y __N Does the employee/guest use vacuum systems and/or cryogenics?

Recommended: EHS0231 COMPRESSED GASES

F01 __Y __N Does the employee/guest work in a research lab or shop area, but is NOT an electrician or electronics technician?

Required: EHS0260 BASIC ELECTRICAL HAZ AWARENESS: RESEARCH

F02 __Y __N Is the employee/guest an electrician or electronics technician?

Required: EHS0250 ELECTRICAL SAFETY/QUALIFIED ELEC WORKERS

Recommended: EHS0123 CPR-3HR-2YR CERTIFICATION

F03 __Y __N Is the employee/guest an electrician or electronics technician who serves as a required safety watch for hazardous electrical operations?

Required: EHS0123 CPR-3HR-2YR CERTIFICATION

G01 __Y __N Does the employee/guest service, maintain, modify, or work on equipment where an unexpected release of energy is a possibility?

One Required: EHS0256 LOCKOUT/TAGOUT TRAINING - OSHA STANDARDS

EHS0257 LOCKOUT/TAGOUT - TRAINING BY SUPERVISOR

H01 __Y __N Does the employee/guest use respiratory protection or directly supervise those who do? (If no, skip to next section.)

H02 __Y __N Does the employee/guest use a half or full-face respirator?

Required: EHS0310 RESPIRATOR TRAINING

Required: EHS0315 SELF-CONTAINED BREATHING APPARATUS TRG

H04 __Y __N Does the employee/guest use an air-line supply respirator?

Required: EHS0312 AIR-LINE SUPPLY RESPIRATOR TRAINING

H05 __Y __N Does the employee/guest ONLY directly supervise users of respiratory protection, but does NOT use a respirator themselves?

Required: EHS0318 TRG FOR SUPERVISORS OF RESPIRATOR USERS

I01 __Y __N Does the employee/guest operate cranes, hoists, and/or forklifts or is a designated trainer for those who do? (If no, skip to next section.)

I02 __Y __N Does the employee/guest operate a forklift?

Required: EHS0225 FORKLIFT CERTIFICATION

EHS0226 FORKLIFT RECERTIFICATION TRAINING *

I03 __Y __N Does the employee/guest operate cranes or hoists?

Required: EHS0206 CRANE & HOIST OPERATOR TRAINING

EHS0207 RECERTIFICATION (FOR CRANE EHS0206) *

I04 __Y __N Is the employee/guest a designated crane/hoist or forklift trainer?

Required: EHS0208 HOIST, CRANE & FORKLIFT INSTRUCTOR

EHS0209 RECERTIFICATION (FOR CRANE EHS0208) *

J01 __Y __N Does the employee/guest perform work in a confined space (e.g., tanks, ducts, trenches, underground vaults)?

Required: EHS0275 CONFINED SPACE HAZARDS

J02 __Y __N Does the employee/guest use atmospheric testing instruments for confined spaces?

Required: EHS0270 GAS DETECTOR INSTRUMENTATION

J03 __Y __N Does the employee/guest directly supervise those who perform work in a confined space?

Recommended: EHS0275 CONFINED SPACE HAZARDS

K01 __Y __N Does the employee/guest work for, or is matrixed to, a research division (AFRD, E&E, ESD, LSD, MSD, CSD, NSD, Physics, SBD, NERSC)? (If no, skip to next section.)

K02 __Y __N Does the emp./guest handle human blood/products, tissue cultures, spores, bacteria, viruses, or other possibly infectious material of human origin?

Required: EHS0737 BLOOD BIOSAFETY & MEDICAL WASTE TRAINING

EHS0738 BLOOD BIOSAFETY RETRAINING *

K03 __Y __N Does the employee/guest operate a Class 3B or Class 4 laser (does not include laser printers or laser pointers)?

Required: EHS0280 LASER SAFETY

K04 __Y __N Does the employee/guest ONLY directly supervise a Class 3B or 4 laser user?

Recommended: EHS0280 LASER SAFETY

K05 __Y __N Does the employee/guest work at the Advanced Light Source (ALS)?

Required: ALS1001 SAFETY AT THE ADVANCED LIGHT SOURCE

EHS0405 GENERAL EMPLOYEE RADIATION TRAINING

EHS0406 GERT REFRESHER *

K06 __Y __N Does the employee/guest do field work at a site which may be contaminated with hazardous materials or is an uncontrolled haz waste site?

Required: EHS0652 HAZ WASTE OPS&ER TRAINING/40 HOUR

EHS0654 HAZ WASTE OPS&ER TRAINING/8HR REFRESH *

K07 __Y __N Does the employee/guest drive, transport, or package hazardous and/or radioactive materials?

Required: MAT0002 DOT HAZARDOUS MATERIALS TRANSPORT REGS

MAT0003 HAZARDOUS MATERIALS TRAINING RECERT. *

K08 __Y __N Does the employee/guest work in or occupy a high-noise area, where the average noise level is above 85 dBA (normal conversation is difficult)?

Required: EHS0285 HEARING CONSERVATION

K09 __Y __N Is the employee/guest the designated responsible person for a Waste Accumulation Area (WAA)?

Required: EHS0610 WASTE ACCUMULATION AREAS

K10 __Y __N Does the employee/guest weld, grind, sand, or work on painted surfaces where paint particles could become airborne?

Required: EHS0330 LEAD HAZARDS AWARENESS

K11 __Y __N Does the employee/guest melt lead in operations other than electronic soldering?

Required: EHS0330 LEAD HAZARDS AWARENESS

K12 __Y __N Does the employee/guest handle extensive amounts of lead bricks (more than 20 bricks per work shift)?

Required: EHS0330 LEAD HAZARDS AWARENESS

L01 __Y __N Does the employee/guest work for a support division (Operations, EH&S ICSD, Engineering, Facilities) and is not matrixed to other divisions? (If no, skip to next section.)

L02 __Y __N Does the employee/guest perform work on construction/renovation projects where contact with radioactive material or contamination is possible?

Required: EHS0420 SAFETY ORIENTATION

L03 __Y __N Does the employee/guest work at the Advanced Light Source (ALS)?

Required: ALS1001 SAFETY AT THE ADVANCED LIGHT SOURCE

EHS0405 GENERAL EMPLOYEE RADIATION TRAINING

EHS0406 GERT REFRESHER *

L04 __Y __N Does the employee/guest drive, transport, package, or sign manifests for hazardous and/or radioactive materials?

Required: MAT0002 DOT HAZARDOUS MATERIALS TRANSPORT REGS

MAT0003 HAZARDOUS MATERIALS TRAINING RECERT. *

L05 __Y __N Does the employee/guest work in or occupy a high-noise area, where the average noise level is above 85 dBA (normal conversation is difficult)?

Required: EHS0285 HEARING CONSERVATION

L06 __Y __N Does the employee/guest remove or disturb (i.e., machine, penetrate, or pulverize) asbestos-containing materials (e.g., floor tiles, roofing)?

Required: EHS0322 ASBESTOS WORKER TRAINING-EPA/OSHA

EHS0323 ASBESTOS WORKER REFRESHER - 8 HRS *

L07 __Y __N Does the employee/guest directly supervise workers who remove asbestos- containing materials?

Required: EHS0324 CONTRACTOR/SUPERVISOR ASBESTOS TRAINING

EHS0325 CONTRACTOR/SUPERVISOR ASBESTOS REFRESH *

L08 __Y __N Does the employee/guest do field work at a site which may be contaminated with hazardous materials or is an uncontrolled haz waste site?

Required: EHS0652 HAZ WASTE OPS&ER TRAINING/40 HOUR

EHS0654 HAZ WASTE OPS&ER TRAINING/8HR REFRESH *

L09 __Y __N Does the employee/guest operate GUN POWDER-Actuated fastening tools?

Required: EHS0242 POWDER ACTUATED TOOL TRAINING

L10 __Y __N Is the employee/guest a designated operator of a waste Fixed Treatment Unit in Building 2, 25, 70A, 70F, 76, or 77?

Required: EHS0650 HAZ WASTE OPS & ER TRAINING/24 HR.

EHS0654 HAZ WASTE OPS&ER TRAINING/8HR REFRESH *

L11 __Y __N Is the employee/guest a Radiation Control Technician in the EH&S Division?

Required: EHS0480 RCT PHASE FUNDAMENTALS

EHS0485 RCT APPLIED TRAINING

EHS0487 RCT ASSIGMENT-SPECIFIC TRAINING

L12 __Y __N Is the employee/guest the designated responsible person for a Waste Accumulation Area (WAA)?

Required: EHS0610 WASTE ACCUMULATION AREAS

L13 __Y __N Does the employee/guest weld, grind, sand, or work on painted surfaces where paint particles could become airborne?

Required: EHS0330 LEAD HAZARDS AWARENESS

L14 __Y __N Does the employee/guest melt lead in operations other than electronic soldering?

Required: EHS0330 LEAD HAZARDS AWARENESS

L15 __Y __N Does the employee/guest handle extensive amounts of lead bricks (more than 20 bricks per work shift)?

Required: EHS0330 LEAD HAZARDS AWARENESS

M01 __Y __N Is the employee/guest a member of the Waste Management Group (WM) in the EH&S division? (If no, skip to next section.)

M02 __Y __N Is the employee/guest a member of the Hazardous Waste Handling Facility (HWHF) Operations Group?

Required: EHS0116 FIRST AID-4HR-3YR CERTIFICATION

EHS0123 CPR-3HR-2YR CERTIFICATION

EHS0530 FIRE EXTINGUISHER SAFETY

EHS0652 HAZ WASTE OPS&ER TRAINING/40 HOUR

EHS0654 HAZ WASTE OPS&ER TRAINING/8HR REFRESH *

ENV0630 HWHF CONTINGENCY PLAN TRAINING

ENV0645 RCRA PART B TRAINING

ENV0646 RCRA, PART B ANNUAL RE-TRAINING *

ENV0821 HAZARDOUS MATERIALS SAMPLING TRAINING

ENV6392 SITE-SPECIFIC HAZARD COMMUNICATION

M03 __Y __N Is the employee/guest a member of the Operations Group who handles radioactive waste at HWHF?

Required: ENV1820 CHARACTERIZATION

ENV1825 PROCESSING LLW,MW,TRU WASTE AT HWHF

ENV1827 ON SITE TRANSFER OF RAD AND MW TO HWHF

ENV1828 OFFSITE TRANSFER OF RAD AND MW TO HWHF

ENV1829 TRACKING OF LLW, MW, AND TRU WASTE

ENV1833 DISCHARGE OF LL,DECAYED AQUEOUS WASTE

ENV1840 QA AND COMPACTION OF SOLID LLW

ENV1845 PACKAGING OF LL ADSORBED TRITIUM

ENV1850 CONSOL. OF MW IGNITABLE LIQUIDS IN UNITH

ENV1868 RELEASE OF HAZARDOUS WASTE FROM RMA

ENV1883 EMPTY CONTAINER DISPOSAL

M04 __Y __N Is the employee/guest a member of the Certification Team?

Required: EHS0654 HAZ WASTE OPS&ER TRAINING/8HR REFRESH *

ENV0630 HWHF CONTINGENCY PLAN TRAINING

ENV0645 RCRA PART B TRAINING

ENV0646 RCRA, PART B ANNUAL RE-TRAINING *

ENV1820 CHARACTERIZATION

ENV1829 TRACKING OF LLW, MW, AND TRU WASTE

ENV1845 PACKAGING OF LL ADSORBED TRITIUM

ENV6392 SITE-SPECIFIC HAZARD COMMUNICATION

One Required: EHS0650 HAZ WASTE OPS & ER TRAINING/24 HR.

EHS0652 HAZ WASTE OPS&ER TRAINING/40 HOUR

M05 __Y __N Is the employee/guest a member of the Compliance Team?

Required: EHS0654 HAZ WASTE OPS&ER TRAINING/8HR REFRESH *

ENV0630 HWHF CONTINGENCY PLAN TRAINING

ENV0645 RCRA PART B TRAINING

ENV0646 RCRA, PART B ANNUAL RE-TRAINING *

ENV1820 CHARACTERIZATION

ENV1829 TRACKING OF LLW, MW, AND TRU WASTE

ENV6392 SITE-SPECIFIC HAZARD COMMUNICATION

One Required: EHS0650 HAZ WASTE OPS & ER TRAINING/24 HR.

EHS0652 HAZ WASTE OPS&ER TRAINING/40 HOUR

M06 __Y __N Is the employee/guest responsible for certification of waste for shipment to TSDFs?

Required: ENV0653 HANFORD WASTE DESIGNATION TRAINING

ENV1831 HANFORD'S DOCUMENTATION RELEASE PROCED.

M07 __Y __N Is the employee/guest a member of the Waste Minimization Generator Assistance Team?

Required: EHS0654 HAZ WASTE OPS&ER TRAINING/8HR REFRESH *

ENV0653 HANFORD WASTE DESIGNATION TRAINING

One Required: EHS0650 HAZ WASTE OPS & ER TRAINING/24 HR.

EHS0652 HAZ WASTE OPS&ER TRAINING/40 HOUR

M08 __Y __N Does the employee/guest supervise personnel or serve in the Waste Mangement Team Leader position?

Required: EHS0653 HAZ WASTE OPS AND ER TRAIN. FOR SUPERVIS

M09 __Y __N Is the employee/guest responsible for training HWHF personnel?

Required: ENV0651 TRAIN THE TRAINER

M10 __Y __N Is the employee/guest responsible for procurement of material at HWHF?

Required: ENV1822 CONTAINER PROCURMENT, RECEIPT,& CONTROL

M11 __Y __N Is the employee/guest a member of the WM group responsible for the HWHF inspection and/or WAA inspection?

Required: ENV1815 INSPECTIONS

N01 __Y __N Does the employee/guest work at the 88" Cyclotron? (If no, skip to required signature area.)

N02 __Y __N Is the employee/guest a Cyclotron Operator?

Required: NSD1002 VAULT RADIATION SURVEY PROCEDURE TR

NSD1003 EXPERIMENTAL AREA SURVEY PROCEDURE TR

NSD1004 VAULT SEARCH & SECURE PROCEDURE TRAINING

NSD1005 PIT SEARCH & SECURE PROCEDURE TRAINING

NSD1006 TRENCH SEARCH & SECURE PROCEDURE TR

NSD1007 CAVES SEARCH & SECURE PROCEDURE TR

NSD1016 VAULT ROOF SEARCH & SECURE PROCEDURE TR

NSD1017 BLDG.88 LOTO PROCEDURE TRAINING

Required: NSD1018 OXYGEN DEFICIENCY HAZARD SURVEY PROC TR

NSD1019 SLAMMER VALVE OPERATING PROCEDURE TR

NSD1020 OPERATORS AIDS POSTING PROCEDURE TR

NSD1021 SHIFT CHANGE-OVER PROCEDURE

N03 __Y __N Does the employee/guest perform electronic maintenance (EM), electronic installation (EI), or electrician duties at the Cyclotron?

Required: NSD1001 SAFETY CHAIN CHECK PROCEDURE TRAINING

NSD1017 BLDG.88 LOTO PROCEDURE TRAINING

N04 __Y __N Does the employee/guest operate a crane at the Cyclotron?

Required: NSD1023 DEFLECTOR BLOCK MOVING PROCEDURE TR

N05 __Y __N Does the employee/guest perform Mechanical Technician duties at the Cyclotron?

Required: NSD1022 CYCLOTRON RF RESONATOR TANK ENTRY PROC

N06 __Y __N Does the employee/guest run experiments using the Cyclotron beam?

Required: NSD1007 CAVES SEARCH & SECURE PROCEDURE TR

NSD3002 88" CYCLOTRON SHIFT EXPERIMENTER TR

N07 __Y __N Does the employee/guest use the isobutane flammable gas system?

Required: NSD2165 FLAMMABLE GAS AND PROCEDURE TRAINING

N08 __Y __N Does the employee/guest use the 88" Machine Shop on an occasional basis?

Required: NSD3003 EXPERIMENTER MACHINE SHOP SAFETY TRAIN.