Renewal application

ATTACHMENT E

NIOSH Spirometry Course Sponsorship

Renewal Application

Form Approved

OMB NO. 0920-0138

Expiration Date: xx/xx/20xx

NIOSH Spirometry Course Sponsorship

Renewal Application

TRAINING REQUIREMENTS OF THE COTTON DUST STANDARD

Authority for approval of training courses in pulmonary function testing as required in the Cotton Dust Standard, 29 CFR 1910.1043, has been delegated to the National Institute for Occupational Safety and Health.

In order to expedite processing of applications for approval, it would be appreciated if you electronically submit your copy of all material requested. Materials may also be mailed.

Kathleen S Rogers, BS, RRT, CPFT

CDC/NIOSH

Respiratory Health Division

Mail Stop H-G900.2

1000 Frederick Lane

Morgantown, West Virginia 26508

Ph: 304-285-6022

Email: [email protected]

The Pulmonary Function Testing Course Approval application which provides guidelines for faculty, content, and equipment is attached along with model course objectives and Appendix D of the Standard.

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Public reporting burden of this collection of information is estimated to average 6 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0138).

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NIOSH-Approved Spirometry Course Sponsorship Renewal Application

Please carefully complete all the questions below (print or type). The course content requirements are derived from the Cotton Dust Standard and additional NIOSH requirements. You will be requested at the end of this form to certify that in your professional judgment, you meet these minimum requirements.

1. NIOSH Course Sponsor #, Name, Address, Telephone Number, and e-mail:

NIOSH-Approved Course Sponsor # _______

If your sponsorship has more than one course director who uses the same manuals, handouts, equipment, and faculty, please list here the names of all directors who use these materials. Otherwise, each course director must submit a separate renewal application.

2. Initial Course Design, Content, and Frequency:

1. Course Design: The course should consist of approximately 16 hours of instruction:

1. At least 4 hours of formal lectures and/or audio-visual material,

2. At least 8 hours of small group practical instruction with no more than six students per instructor,

3. At least 2 hours per student devoted to evaluation and testing of the student’s spirometric testing skills.

4. Two hours to be used at the course director’s discretion for pertinent activities or topics.

b. Course Content for the requirements in (2.a.) should include:

1. Basic physiology of the forced vital capacity maneuver and the determinants of airflow limitation with emphasis on the relation to repeatability of results.

2. Instrumentation requirements including calibration procedures, sources of error, and their correction.

3. The most current ATS/ERS Standardization Guidelines for spirometry testing.

4. Performance of testing including subject coaching, recognition of improperly performed maneuvers, and corrective actions.

5. Data quality with emphasis on repeatability.

6. Actual use of the equipment under supervised conditions.

7. Measurement of tracings and calculations of results.

If a substantial amount of material exclusive of the above, i.e., beyond minimum requirements as set forth in The Cotton Dust Standard is taught, it must be taught in addition to the minimum 16 hours of course time.

The sponsorship renewal’s course offerings will have:

_________ Hours of Lecture

_________ Hours of Practicum

_________ Hours of Evaluation

Hours of Extra Activity

An agenda showing lecture topics, time allocations, and lecturers’ names must be attached to this renewal application.

c. Course Frequency

Each course director must teach at least one course and a total of five students each calendar year. Failure to meet these minimum requirements will result in suspension of course approval.

3. Course Materials

Course materials should adequately cover the required course content (Item 4b above). NIOSH has developed a course outline and other materials that you may use to develop your own curriculum. Submit one copy of all instructional materials, including PowerPoint, internet links, and student handouts. You will be required to use standardized evaluation materials, specifically, the written examination and the criteria used to evaluate student performance (practical examination) provided by NIOSH.

4. NIOSH-Approved Faculty:

Attached to this form, you will find a table listing currently approved faculty for your sponsor. Please indicate if an individual is no longer teaching in your course. For new faculty applicants, please forward a request to NIOSH for their approval and include a current CV from that individual.

5. List of Practicum Equipment:

1. Spirometers:

At least one Spirometry System shall be provided for every six students. All of the spirometers used must meet the minimum equipment requirements (CFR Section 1910.1043, Appendix D. I, a to j) and current ATS/ERS standards. List specific equipment below.

Manufacturer	Model No.	Approximate Date Acquired
1.
2.
3.
4.
5.

1. Calibration Syringes:

There shall be a minimum ratio of one 3 liter calibrating syringe for every two spirometry systems. List the manufacturer and current manufacturer’s calibration certification date.

Manufacturer	Current manufacture’s calibration certification date
1.
2.
3.

6. Certificate of Course Completion:

A certificate showing satisfactory completion of the course must be provided to each trainee. The certificate should contain the following information

1. A non-removable watermark

2. Course director’s signature

3. Course dates

4. NIOSH-approved Sponsorship Course approval number

5. A statement that the certificate is valid for 5 years and 7 months from the date of the course

6. Any CEUs awarded

NOTE: NIOSH’s approval of the course means that the Course Sponsorship meets the minimum technical requirements for teaching spirometry testing as set forth in the Cotton Dust Standard (29 CFR 1910.1043 and 1910.1046). It does not constitute NIOSH certification of individuals completing the course.

7. Notification Procedures

Any changes in course faculty, content, or equipment must be reported to NIOSH for approval.

All dates of prospective courses must be submitted to NIOSH at least 30 days prior to such courses. (Telephone or electronic notification, as soon as a course date is known, is required in cases when a course is scheduled without time for the 30-day notice).

The sponsor will provide NIOSH with course dates and the number of students for each course completed on an annual basis, or sooner if the sponsor wishes. A sample report form will be made available on the secure course director’s web page.

8. Course Director Certification

I hereby certify that I have reviewed and understand the Medical Surveillance Requirements as stated in the Cotton Dust Standard. I certify that course content, materials, equipment and faculty are adequate and meet minimum requirements. I have completed this form as accurately and fully as possible. I understand that if during a NIOSH site visit the course does not comply with the application criteria and statement I have made, approval will be withdrawn.

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Course Director Signature Date

ATTACHMENT 1

APPROVED FACULTY LIST FOR YOUR SPONSOR

Listed below are the names of faculty members who have been approved by NIOSH to teach in your sponsor’s NIOSH-Approved Spirometry Training Course. Please review the faculty names and indicate if the individual is no longer teaching. If you are a course director in a geographically different location than the course sponsor, please indicate only those members who have assisted you in your immediate course.

NIOSH Sponsor #_____:

Faculty Member’s Name	Course Director	Lecturer	Practicum Instructor	No Longer Teaching
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