Pursuant to Section 763.84 and 763.93 of the United States Environmental Protection Agency Asbestos in Schools
Regulation (40 CFR Part 763), each management plan must contain a true and correct statement, signed by the
local education agency (LEA) designated person, that certifies that the general LEA responsibilities have been
met. This form is provided to assist you complying with this portion of AHERA.
LEA Name ___________________________________________________________________
LEA Address _________________________________________________________________
Designated Person Name _______________________________________________________
Designated Person Address _____________________________________________________
This AHERA management plan was developed and has been submitted pursuant to the Asbestos Hazard
Emergency Response Act of 1989, Public Law 99-159; and the United States Environmental Protection Agency
Rule: Asbestos Containing Materials in Schools. 40 CFR Part 763; and the undersigned does hereby certify that
the LEA has and will ensure the following:
1. The activities of any persons who perform inspections, re-inspections, and periodic surveillance, develop
and update the management plans, and develop and implement response actions, including operations
and maintenance, are carried out in accordance with Part 763.
2. All custodial and maintenance employees are properly trained as required in Part 763 and all other applicable
federal and/or state regulations (e.g., the Occupational Safety and Health Administration Asbestos Standard
for Construction, the EPA Worker Protection Rule, or applicable state regulations.
3. All workers and building occupants, or their legal guardians, are informed at least once each school year
about inspections, response actions, and post-response action activities, including periodic re-inspection
and surveillance activities, that are planned or in progress.
4. All short-term workers (e.g., telephone repair workers, utility workers, or exterminators) who may come in
contact with asbestos in a school are provided information regarding the locations of asbestos containing
building materials (ACBM) and suspected ACBM assumed to have asbestos containing materials (ACM).
5. All warning labels are posted in accordance with Section 763.95.
6. All management plans are available for inspection and notification of such availability has been provided
as specified in the management plan under Section 763.93(g).
7. The undersigned person designated by the LEA pursuant to Section 763.84(g)(1) has received adequate
training as stipulated in Section 763.84(g)(2).
8. The LEA has and will consider whether any conflict of interest may arise from the interrelationship among
accredited personnel and whether that should influence the selection of accredited personnel to perform
activities under Part 763.
Signed ___________________________________________________ Date:_________________________
LEA Designated Person, pursuant to 40 CFR 763.93(i) and 763.84
State of Illinois
Illinois Department of Public Health
IOCI 13-316