ASB-SF-010 Supervisor Certificate of Cleanliness Inspection.v3

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Job Ref:

• Client Name:

• Client Tel:

• Client Address:

• Client Email:

• Client Contact Name:

• Site Address:

Site & Enclosure Details

• Work Area: (see PoW)

• Size of Work Area - L x W x H (see PoW)

• Has full access of the site been obtained?

  Yes

  No

  N/A

• Has a new pre filter been installed in the NPU(s)?

  Yes

  No

  N/A

• Have all ACM removal locations been checked and certified as free from asbestos?

  Yes

  No

  N/A

• Have all floor surfaces/walls/items been inspected and confirmed as visually clean?

  Yes

  No

  N/A

• Have all ledges, sills, higher level surfaces (including voids where appropriate) been inspected and confirmed as visually clean?

  Yes

  No

  N/A

• Have all cables, wiring, piping, ducting etc been checked and confirmed as visually clean?

  Yes

  No

  N/A

• Have all items or equipment brought into or remaining in the work area/enclosure for the clearance procedure (including scaffolding and large waste items) been checked and confirmed as visually clean?

  Yes

  No

  N/A

• Supervisors visual inspection start time:

  Date

• Supervisors visual inspection finish time:

  Date

• How long did the visual inspection take? Total time in hours/minutes:

• I certify that I have carried out a thorough visual inspection of the enclosure/work area and can confirm that the area is visually clean and ready to be re-occupied.

  Sign

• I certify that I have carried out a thorough visual inspection of the enclosure/work area and can confirm that the area is visually clean and ready to be made available to the analyst for the independent Air Test.

  Sign

• Type of Air Test:

• Number of Pumps Required:

• Analyst Signature:

  Sign

• Name:

• Position:

• Analytical Company:

• Date:

  Date

• Supervisor Signature:

  Sign

• Name:

• Company:

• Date:

  Date