Form Dhec 3422 PDF Details

The DHEC 3422 form serves as a critical document for entities seeking a Group License in the asbestos sector. It is meticulously structured to capture essential details, beginning with basic organizational information such as the company name, mailing, and street addresses. It also requires the identification of the company official and their title, along with contact information, to ensure clear and direct lines of communication. Intricately linked to workforce management, the form delves into specific personnel details, including names, social security numbers, and disciplines, alongside their training outcomes marked as pass or fail, with corresponding training providers, instructors, and exam dates. This meticulous documentation underpins the form’s intent to regulate and oversee asbestos-related activities safely and responsibly. Additionally, it outlines a tiered fee schedule based on the number of personnel involved, starting from a minimum fee for up to 10 people and increasing incrementally, aimed at making the licensing process scalable and financially structured for groups of various sizes. The completion and signing of this form signify an important step towards compliance with regulations governing asbestos management, highlighting its crucial role in safeguarding public health and ensuring the integrity of asbestos management practices.

QuestionAnswer
Form NameForm Dhec 3422
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesd 3422 dhec asbestos section form

Form Preview Example

 

 

Application Form For Group License

 

 

 

 

Asbestos Section

 

 

1. Company Name:

 

 

4. Group License Number:

 

2. Mailing Address:

 

 

5. Company Official:

 

 

 

 

 

6. Title:

 

 

(City)

 

(State)

(Zipcode)

7. Telephone #:

 

 

3. Street Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

8. In-house Contractor:

 

(City)

 

(State)

(Zipcode)

 

 

 

Name

 

SS Number

Discipline

(P)ass

Training Provider/Instructor

Exam Date

 

(F)ail

(MM/DD/YYYY)

DHEC 3422

8/96

 

 

 

 

 

Disciplines Under Group License

Class IV Worker Disturbing RACM

O & M Worker

Roofer Worker

Roofer Supervisor

AHERA Worker

AHERA Supervisor

Air Sampler

Project Designer

Building Inspector

Mgmt. Planner

Fee Schedule For Group License

up to 10 people

$

25.00 minimum fee

11th to 20th person

$

2.50

per person

21st to 50th person

$

5.00

per person

51st to 90th person

$

7.50

per person

91st or more persons

$500.00 maximum fee

Name

SS Number

Discipline (Pass/Fail)

Training Provider/Instructor Exam Date

10.Total Fee Due:

11.Signature: