Asbestos Permit To Work Copy

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Section 1: Location and description of work

• Work information

  Media

• Date/s for Works/ Activity:

  Date

Section 2: Asbestos Register

• 2.1 Has the Asbestos Register been reviewed by the staff member/Contractors?

• 2.2 Will the work disturb any asbestos containing material?

• If the answer to 2.2 is YES - proceed to Section 3; if NO - proceed to section 4

Section 3: Work ON asbestos containing materials

• 3.1 Contractors competency to work on ACM's been confirmed?

• 3.2 Worked planned in accordance with the requirements of The Control Of Asbestos Regulations 2012?

• 3.3 Bursar/Site Manager been informed and given approal?

• Work can commence once the above are confirmed

Section 4: Activity/Work NEAR asbestos containing materials

• 4.1 Has a method statement been prepared for the work?

• The activity/works can commence once the above is confirmed but must stop immediately if any suspicious materials are discovered

Section 5: School Approval

• Signature:

  Sign

• Print Name:

  Sign

• Select date

  Date

Section 6: Staff/Contractor Confirmation I confirm that the activity/work will be undertaken in accordance with the requirements of this permit and school asbestos management plan.

• Signature:

  Sign

• Print Name:

  Sign

• Company Name:

• Date

  Date