Construction Subcontractor Employee Training Matrix

Contractor Name: Date:

Project Name: LBNL Const. Mgr:

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 (dllendahl@lbl.gov) 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 (dllendahl@lbl.gov).

Qualitative Respirator Fit

Excavation, Scaffolding
Qualified Person- LOTO
Respirator Use Medical

Quantitative Respirator
Silica /Lead / Asbestos
Use of Fall Protection

Respiratory Program
Scissor or Boom Lift

Competent Person-
Qualified Electrical
GERT / Orientation

Crane Operations
Qualified Person-
Fire Extinguisher

Traffic / Flaggers

Confined Space
Fall Protection
Scaffold User

Awareness

Clearance

Electrical
Fit Test

Worker
Ladder

PPE

Test
Employee Name

10

11

12

13

14

15

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

Signature: Date: