014 RMS Surveillance Checklist H14 ASBESTOS REMOVAL/DISTURBANCE

• H14 ASBESTOS REMOVAL/DISTURBANCE .

• Project Name: Tabulam New Bridge.

• Location: BRUXNER HIGHWAY TABULAM

• Contractor

• Prepared by

• Conducted on

  Date

• N.A Not Applicable. N.C Not Checked

1 Does the contractor have a WorkCover licence for:

•  Friable asbestos activities that will take longer than 1 hour work?

  Yes

  No

  N.A.

  N.C.

•  Removal or disturbance of bonded asbestos within a 10 square metre limit?

  Yes

  No

  N/A

• 3<br>Has a risk assessment been completed by a technically competent person prior to commencing work with asbestos contaminated material (ACM)?

  Yes

  No

  N/A

• 4<br>Is asbestos waste removed by a competent person?

  Yes

  No

  N.A.

  N.C.

• 5<br>Are there SWMS for activities involving ACM?

  Yes

  No

  N.A.

  N.C.

• 6<br>Are responsibilities for the security and safety of the asbestos removal site and asbestos work area specified in the asbestos removal control plan?<br>

  Yes

  No

  N.A.

  N.C.

• 7<br>Has health surveillance for staff potentially exposed to asbestos been implemented as determined by a risk assessment, i.e. ongoing or periodic atmospheric monitoring?

  Yes

  No

  N.A.

  N.C.

• 8<br>Is air monitoring completed by a competent person (usually a qualified occupational hygienist)?

  Yes

  No

  N.A.

  N.C.

9 Have all persons exposed to ACM been trained in:

•  Identification and signage of areas where ACM is known to exist?

  Yes

  No

  N.A.

  N.C.

•  Dealing with the hazards involved?

  Yes

  No

  N.A.

  N.C.

•  Systems of work and other control measures?<br>

  Yes

  No

  N.A.

  N.C.

•  PPE use, care and maintenance?

  Yes

  No

  N.A.

  N.C.

•  Emergency procedures?

  Yes

  No

  N.A.

  N.C.

• 10<br>Is all ACM clearly labelled?

  Yes

  No

  N.A.

  N.C.

• 11<br>Is there a satisfactory decontamination procedure for cleaning the site once the work is completed?

  Yes

  No

  N.A.

  N.C.

• 12<br>Has a clearance been provided by a competent person prior to re-occupying the area?

  Yes

  No

  N.A.

  N.C.

• Is the activity compliant.

  Yes

  No

  N.A.

  N.C.

• Surveillance Officer

  Sign

• NCPN or memo number.

  Yes

  No

  N/A

• Follow up action

  Yes

  No

  N/A

• Product Non Conformance

  Yes

  No

  N/A

• System Non Conformance

  Yes

  No

  N/A

• Contractor generated NCR

  Yes

  No

  N/A

• Contractor generated a CAR

  Yes

  No

  N/A

Matters arising

• NCPN no

• Contractors NCR no

• CAR no

• Closed out.

• RMS representative's name

  Sign