Title Page

  • Select Site

  • Site Address
  • Conducted on

  • List ACM's being removed?

  • Carried out by (Site Supervisor)

  • Contract Manager for this project

  • Building Name or number ?

  • Enclosure / Area number ?

  • 1.1 Is the plan of work of a good enough standard to proceed and does it reflect the site conditions? (Licensed works, ASB5 attached) If answer is NO, send photo amendments

  • 1.2 Have all site staff been briefed on the contents of the plan of work and informed of risks? Take Photo of Paperwork:

  • 1.3 Have other contractors based at this site been briefed on the work? Take Photo of Paperwork:

  • 1.4 Do you have copies or access to all of the following documentation? Internal Training certs, Specialist Training certs, Face Fits, 6 Mthly Respirator certs, Mthly Mask checks, Medical certs, Equipment certs

  • 1.5 Is the DCU in the best position, operational and in good working order and has: All certs up to date, EZplug, CO2 Alarm, Bull Bar/Wheel Lock, Good Earth and Clean Water filter. Take Photo of DCU:

  • 1.6 Is the access(entry) to and egress (exit) from work areas(s), including routes (Transit/Waste) clearly signed with Lawson signage and free from debris. Potential hazards marked with hazard tape and controlled areas cordoned off with barrier tape? Take Photo of routes

  • 1.7 Are the following items available: valid Insurance cert & Asbestos License, Waste Carrier License, Site Documentation, Fire Extinguisher, First aid kit, Air horn, Supervisor name & Contact No. Take Photo of Fire Extinguisher, First aid kit, Air horn by enclosure entry point:

  • 1.8 Are the following safety warning signs, as well as barrier tape identifying the asbestos and respirator zones, in place? No Unauthorised Access, Wear RPE, Wear Coveralls, Danger Asbestos. Take Photo of Signage:

  • 1.9 Has the access equipment been set up correctly, filling in the relevant checklist or risk assessment if necessary? Signatory must have valid training: PASMA for access Tower, IPAF for MEWP, Fixed scaffold: Fit for purpose and Scaff tagged, Confined Space or Restricted access: Assessed and qualified

  • 1.10 If an external contractor has set up the equipment, do you have copies of the necessary certs? Take Photo of certs:

  • 1.11 Has the gas been purged, electrical equipment and lighting been isolated? Do you have copies of the certs? Take Photo of certs:

  • 1.12 Has all RPE been checked and has the check sheet been completed? Take Photo of Paperwork:

  • 1.13 Are all personnel expected to wear RPE clean shaven? Supervisor, Operatives, Visitors; ie Analyst.

  • 1.14 Are all personnel wearing the correct PPE?

  • 1.15 Have all points on the daily inspection sheet been checked and sheet completed?

  • 1.16 Have all NPU had an anemometer reading done?

  • List the readings ?

  • Name of Supervisor:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.