Contractor Asbestos Sign-off Sheet

• Document No.

• Client / Site

  Select

• Date

  Date

• Completed by

• Position/Job Role

• First Line of Address

  Yes

  No

  N/A
• Location
  Address

• Personnel

Section 1: Asbestos Information Provided.

• Date/s for Works/ Activity:

  Date

• Are all operatives trained in Asbestos Awareness?

  Yes

  No

  N/A

• All installers MUST have suitable Asbestos Awareness training, please do not allow any individuals without this training to work on our site.

• Has a Refurbishment/Demolition Survey been provided for the property?

  Yes

  No

  N/A

• DO NOT START WORK ON ANY PROPERTY UNLESS AN ASBESTOS R&D SURVEY HAS BEEN PROVIDED!

• Has the Survey provided identified the presence of Asbestos Containing Materials?

  Yes

  No

  N/A

• Please Continue to the Sign-off (Section 2), ensure all members of your team sign the declaration.

• Is it likely that your work activities disturb any of the ACM's identified?

  Yes

  No

  N/A

• DO NOT PROCEED WITH WORKS UNTIL ACM's HAVE BEEN REMOVED BY AN APPROVED CONTRACTOR OR YOU CAN PLAN YOUR WORK TO AVOID DISTURBING ACM's

Section 2: Staff/Contractor Confirmation: All operatives working on site are required to sign below or should be withdrawn from working on site.
I have read and understood the asbestos survey/report provided for the site location above. All the above
statements are true, and I am competent to complete work at this site location.

• Signature:

  Sign

• Print Name:

  Sign

• Company Name:

• Date

  Date