Asbestos Removal CC

• Note: Where asbestos removal work requires a Class A licence, a licences asbestos assessor must carry out the clearance inspection and complete an asbestos removal clearance certificate if satisfied that the area is safe to reoccupy.

Client Details

• Client Name

• Contact Name

• Contact Phone

Details of Removal Works

• Date Performed

  Date
• Site Address
  Address

• Scope of Works

• Licensed Asbestos Removalist

• Licensed Asbestos Supervisor

inspection Details

• Select date

  Date

• Exclusions (Areas of No Access)

Section B - Asbestos Removal Paperwork

• Did you sight a copy of the asbestos removal control plan?

  Yes

  No

  Not Applicable

• Did you sight a copy of the form 65 Notification form?

  Yes

  No

  Not Applicable

Section C - Asbestos Removal Work Area

Visual Inspection

• Inspection of the specific area detailed in Section A found no visible asbestos remaining as a result of the asbestos work carried out.

  Yes

  No

  Not Applicable

• Is Air Monitoring required?

  Yes

  No

  Not Applicable

• Can the area be re occupied?

  Yes

  No

  Not Applicable

• Has additional information been attached (ie. photos)

  Yes

  No

  Not Applicable

Air Monitoring

• Air Monitoring was carried out as part of the clearance inspection. The result was below 0.01 f/ml

  Yes

  No

  Not Applicable

• Has the Air Monitoring sample been analysed by a NATA accredited Laboratory?

  Yes

  No

  Not Applicable

• Is the Air Monitoring report attached?

  Yes

  No

  N/A

• Can the area be re occupied?

  Yes

  No

  Not Applicable

Section D - Enclosures

Prior to dismantling Enclosure

• The area within the enclosure and the area immediately surrounding the enclosure was inspected and no visible asbestos was found.

  Yes

  No

  Not Applicable

• Air Monitoring was carried out as part of he clearance inspection. The result was below 0.01 f/ml.

  Yes

  No

  Not Applicable

• Is the air monitoring report attached?

  Yes

  No

  Not Applicable

• Can the enclosure be dismantled?

  Yes

  No

  Not Applicable

After the enclosure was dismantled and removed

• The area immediately surrounding the removal work zone was inspected and no visible asbestos was found.

  Yes

  No

  Not Applicable

• Air Monitoring was carried out as part of he clearance inspection. The result was below 0.01 f/ml.

  Yes

  No

  Not Applicable

• Is the Air Monitoring report attached?

  Yes

  No

  N/A

• Can the area be reoccupied?

  Yes

  No

  Not Applicable

Section E -Clearance Declaration

• I declare that:
  
  1. The former enclosure and/or asbestos removal work area and the surrounding area
  
  2. The transit route and waste routes are free from any asbestos, and
  
  3. All asbestos in the scope of the removal works has been removed and any known asbestos is intact.

• Add signature

  Sign

• Name of a licences Assessor

• Assessor Licence Number (If Applicable)

• Select date

  Date