Anonymous

Asbestos Annual Visual Inspection

Use this Template

Print as PDF

Use this Template

Go digital today!

Convert your paper checklists into digital forms

Scan this QR code to use this paper checklist on your smartphone or tablet or visit https://safetyculture.com/

Title Page

Building Name
Conducted On
Prepared by
Accrediation Number

Click To Add New ACM
Material Description
Material Location
Approximate Quantity
Confirmed or PACM?
- Asbestos Containing Material
- Presumed Asbestos Containing Material
Material Category
Friability?
Damage Assessment
- 1 - Significant Damage/Potential For Disturbance
- 2 - Damage/High Potential For Disturbance
- 3 - Damage/Moderate Potential For Disturbance
- 4 - Damaged/Low Potential For Disturbance
- 5 - Good/High Potential For Significant Damage
- 6 - Good/Moderate Potential For Damage
- 7 - Good/Low Potential For Damage
- N/A
Photo of ACM.
Change in Assesment
Preventative Measures/Response Actions
Additional Comments/Concerns
Additional Photos

Anonymous

Asbestos Annual Visual Inspection

Use this Template

Print as PDF

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.