Asbestos Present - Permit to Work

• Conducted on

  Date

• Prepared by

• Location
  Address

• ASBESTOS PRESENT PERMIT TO WORK NUMBER

• What works will be undertaken?

• Special Tools / Equipment to be Used

• Job Location / Plant Identification Number

• Is any other work currently being undertaken that may interact or affect this permit? (Quote Permit numbers where applicable)

This Permit is only Valid when all sections are complete. If you are in doubt or don't understand, then please ask. Remember, all accidents are preventable and it is people who get hurt and suffer pain. Please use this permit in the spirit intended to protect yourself and others. Please ensure that you sign this permit to work. DO NOT PROCEED WITH YOUR WORK UNTIL YOUR PERMIT HAS BEEN AUTHORISED BY THE RELEVANT MEMBER OF STAFF.

PRIMARY HAZARDS - Asbestos exposure / Mesothelioma / Plural Plaque / Asbestosis / Asbestos Contamination to Site and Products

Please answer the questions truthfully

• Are you Qualified / Trained to undertake this work?

  Yes

  No

  N/A

• Are you Asbestos Awareness Trained?

  Yes

  No

  N/A

• Have you consulted the Site Asbestos Register for the work location?

  Yes

  No

  N/A

• Does the Work involve any process which may liberate asbestos fibres into the air? Cutting / Drilling / Breaking into Asbestos coatings / Sweeping etc?

  Yes

  No

  N/A

• Please describe the type of Asbestos Containing Material e.g Coatings (Limpet / Paint / Artex Plaster) Asbestos Insulation Board (AIB / Asbestolux) Asbestos Cement / OTHER - CALMEC Toilet Tanks / Seats / Vinyl Floor Tiles / Gaskets / Fuse Flash Pads

HSE Licensed Tasks

• Is the Work a HSE Licensed Task Listed Below? 1. Removing sprayed coatings (limpet asbestos) <br>Removal or other work which may disturb pipe lagging <br>2. Any work involving loose fill insulation Work on millboard <br>3. Cleaning up significant quantities of loose/fine debris containing ACM dust (where the work is not sporadic and of low intensity, the control limit will be exceeded or it is not short duration work) <br>4. Work on AIB, where the risk assessment indicates that it will not be of short duration<br>

  Yes

  No

  N/A

• If the work is Licensed - are you HSE Registered as Licensed Asbestos Company?

  Yes

  No

  N/A

Licensed Work can only be undertaken by HSE Licensed Contractor - STOP WORK IF LICENCE IS NOT PRESENT ON SITE.

Non-licensed Tasks

• Is the Work as HSE Non-Licensed Task Below? 1. Small, short duration maintenance tasks where the control limits will not be exceeded (Under 2 Hours) or less than 1 hour per day for 7 consecutive days.<br>2. Removing textured decorative coatings by any suitable dust-reducing method.<br>3. Cleaning up small quantities of loose/ fine debris containing ACM dust (where the work is sporadic and of low intensity, the control limit will not be exceeded and it is short duration work). <br>4. Work on asbestos cement products or other materials containing asbestos (such as paints, bitumen, resins, rubber, etc) where the fibres are bound in a matrix which prevents most of them being released (this includes, typically, aged/weathered AC).<br>5. Work associated with collecting and analysing samples to identify the presence of asbestos.

  Yes

  No

  N/A

• Do you have a copy of the HSE Asbestos Essentials Method Statement for the works you will be undertaking?

  Yes

  No

  N/A

• Do you have the equipment required in the Asbestos Essentials Method Statement? i.e. H Rated Vacuum Cleaner / Dust Extraction Equipment.

  Yes

  No

  N/A

• Is an Air Clearance Test required following works?

  Yes

  No

  N/A

• Have all employees got Type 5 Particle Proof PPE - Suits and Boot Covers?

  Yes

  No

  N/A

• Have all employees got FFP3 Half Masks (RPE) to protect against Asbestos Fibres?

  Yes

  No

  N/A

• Have all employees had an up-to-date Face Fit Test for RPE?

  Yes

  No

  N/A

• Are all employees using RPE Clean Shaven? If No - Work is not Permitted as Mask will not provide protection.

  Yes

  No

  N/A

• Are UN Approved Asbestos Removal Bags present for safely removing waste?

  Yes

  No

  N/A

• Is the Double Bag System in use for waste? Red Inner Bag / Clear Overpack Bag?

  Yes

  No

  N/A

• Do you have a Copy of HSE Asbestos Essentials EM1 Emergency Procedure with you on site?

  Yes

  No

  N/A

OTHER PRECAUTIONS

• Other Precautions Required to undertake the work safely:

• Other Safety Equipment required to undertake the work safely:

• Person in Charge of Works

• Company

• Signature

  Sign

• Authorising Person

PERMIT EXPIRY DETAILS

• Permit Expires on

  Date

• Name of Person Undertaking Air Clearance Test

• Air Clearance Result (WEL is 1 Asbestos Fibre /m3 Air)

• Work Area is safe for persons to enter as WEL has not been exceeded.

  Pass

  Fail

  N/A

BOHS P404 Air Clearance Test is required after licensed tasks or if there has been a risk of contamination to an area, due to liberation of asbestos fibres.

I confirm that the work has been completed, checked by myself, all Asbestos Waste has been correctly packaged and disposed of via a Licensed Waste Contractor and the area left in a safe and tidy condition.

• Person in Charge (Print Name)

• Person in Charge (Signature)

  Sign

I have inspected the completed work, confirmed that Asbestos Waste has been correctly disposed of, and the area has been subject to Air Clearance Test if required and certified as safe. I hereby cancel this permit.

• Authorised Person (Print Name)

• Authorised Person (Signature)

  Sign

PERMIT CANCELLED

• Permit Cancelled

  Date