Methamphetamine-Affected Properties Qualified Instructor Application

General information

Who must apply

All persons who wish to teach training courses for the assessment, decontamination or sampling of methamphetamine-affected properties in the state of Colorado. Department approval is required under 6 CCR 1014-3, Part 2. Approval is valid for two (2) years.

Please check if this is an application for renewal.

Yes

If you are renewing, please enter your cert #. ML-T

Personal information

Personal information

Applicant first name *

Last name *

Applicant address

Address number *

Street direction

Street name *

Street type

Unit/suite#

City (Please type in full name) *

State *

Zip code *

Work phone (xxx-xxx-xxxx) *

Email *

Employer name

Employer address

Address number *

Street direction

Street name *

Street type

Unit/suite#

City

State *

Zip

Identification information

ID type *

State of issue * 🛈

"ID type" must be a photo ID issued by a governmental agency, such as a drivers license, passport or state ID. You must bring this ID to the testing site for verification of your identity.

Do you wish to be included on the department's on-line list of certified instructors? *

Yes

No

Course types

We accept payment by check or money order only. Do not use the asbestos pay portal to pay your methamphetamine-affected properties application fees.

Type(s) of course(s) for which approval is sought (check all that apply)

Consultant (basic and refresher)

Fee $200

Decontamination worker (basic and refresher)

Fee $200

Decontamination supervisor (basic and refresher)

Fee $200

Ventilation contractor

Fee $200

Total fee due

0.00

Required attachments by course

Documentation of high school diploma or GED. *

Consultant

Documentation of compliance with the industrial hygienist qualifications set forth in 24-30-1402, C.R.S., including documentation of degrees and experience claimed or instruction received. Documentation of experience claimed must include submission of employment references, including telephone numbers. *

40-hr HAZWOPER certificate as forth in 29 CFR 1910.120

8-hr HAZWOPER refresher (if applicable)

Documentation demonstrating a minimum of five (5) years of consulting experience. Documentation must include submission of employment references, including telephone numbers. *

Decontamination worker, decontamination supervisor, ventilation contractor

Documentation demonstrating a minimum of five (5) years of field experience in the subject(s) to be taught. Documentation must include submission of employment references, including telephone numbers. *

40-hr HAZWOPER certificate as forth in 29 CFR 1910.120

8-hr HAZWOPER refresher (if applicable)

Definition

A qualified instructor is a person who is approved by the department to teach one or more specific courses in the assessment, decontamination and sampling of methamphetamine-affected properties in the state of Colorado, including: consultant, decontamination worker, decontamination supervisor and ventilation contractor.

Instructions and signature

Instructions

Once you have completed the form, click on the Submit button. We will send an email to you with a link to your completed form that you can then save as a PDF. Follow the instructions for payment provided in the email to complete your submittal.

Note: Your application will not be processed until we receive your payment.

When you hit Submit, you will be redirected to the Methamphetamine-affected properties environmental cleanup web page.

Signature

For the purposes of this form, the Colorado Department of Public Health and Environment accepts your typed name, title and date as an electronic signature equivalent to your valid signature on a paper copy of the form. As such, this electronically completed form subjects the signatory to the same responsibilities as a hand-signed form. Per Section 18-8-306, C.R.S., it is a felony to submit false information to a state official.

Name *

Title *

Date * +