Download IH Pre-Registration form - University of Colorado Boulder

University of Colorado at Boulder
Department of Environmental Health and Safety
Asbestos and Lead Consulting Services
Pre Registration Form
Company Name ______________________________
Contact Name___________________________ Phone___________________________
Email__________________________________
Introduction
The University of Colorado Boulder (UCB) Requests a Statement of Qualifications (RFQ) for
providing as-needed Industrial Hygiene (IH) services related to asbestos and lead projects on the
University of Colorado, Boulder campus. A qualified firm shall have certified staff and
experience in at least one of the following asbestos/lead disciplines:





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Asbestos building inspections
Asbestos project design
Asbestos project management
Air monitoring specialist
Lead inspector
Lead risk assessments
Qualified IH firms working on the UCB campus must be:
 Registered Asbestos consulting firm with the Colorado Department of Public Health and
Environment (CDPHE)
o CDPHE Registration #_______________Expiration Date___________
o # Years working in asbestos and lead field? ___________


In good standing with CDPHE with no recorded Notices of Violation in the past 5 years
Trained and authorized by CU EHS to access the Material Management Database
Selection process
IH Firms will be evaluated and qualified based on CDPHE Asbestos Consultant Registration and
personnel currently certified by CDPHE for each discipline.
Each firm will be required to provide proof of State certified staff on a yearly basis to maintain
current status on the qualified IH provider list. It is the responsibility of all qualified firms to
Department of Environmental Health & Safety
1000 Regent Drive, UCB 413
Boulder, Colorado 80309-0413
(303) 492-6025
FAX: (303) 492-2854
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University of Colorado at Boulder
Department of Environmental Health and Safety
remain certified by CDPHE until the next required submittal date. If there is an increase or
decrease to a consulting Firm’s asbestos and lead capabilities the IH Firm is responsible for
contacting CU EHS ([email protected]) with an update of the changes. All IH firms
providing asbestos and lead services on campus must fully understand the requirements and
expectations set forth in the campus Asbestos program, IH specifications and General Abatement
Contractor specifications. Additionally, IH firms must comply with UCB standards/policies and
all other applicable state and federal regulations when working on campus.
Submittal requirement
Check the box for each of the disciplines your firm is qualified by CDPHE to perform:
Asbestos/Lead Discipline
CU EHS Approval
EHS Use only
Qualified to Provide
Asbestos Building Inspections
Asbestos Air Monitoring
Asbestos Project deign
Asbestos project management
Lead Inspector
Lead Risk Assessments
Populate the following table for each team member who would be assigned to projects at UCB:
Employee Name
Asbestos
Building
Inspector
Cert #
Expiration
Air Monitoring
Specialist
Cert #
Expiration
Asbestos
project Designer
Cert #
Lead Inspector
Expiration
Cert #
Expiration
Lead Risk
Assessor
Cert #
# of Years
in
Industry
Expiration
Has your firm been trained on proper use of Material Management database and has been given
authorization by CU EHS? Yes _______ No _______
Upon completion, submit this document with the As-Needed Consultant Registration Form to
The University of Colorado’s Planning Design and Construction Department.
Department of Environmental Health & Safety
1000 Regent Drive, UCB 413
Boulder, Colorado 80309-0413
(303) 492-6025
FAX: (303) 492-2854
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