Information
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Site address
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Location
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Document No.
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Client
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Conducted on
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Prepared by who?
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Survey available?
- Yes management
- Yes R&D
- Yes other
- No
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Date of Survey
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Survey company
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Type of building
- Office
- Retail
- Residential
- Industrial
- School
- Hospital
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Start date requested by client
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ASB5 Required?
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ASB5 date
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Estimated finish date
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Number of staff
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13 or more
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Type of ACM
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Location? Condition? Fixing details? Survey reference?
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Type of ACM
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Location? Condition? Fixing details? Survey reference?
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Type of ACM
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Location? Condition? Fixing details? Survey reference?
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Type of ACM
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Location? Condition? Fixing details? Survey reference?
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Any other ACM and details
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Description of works
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Scope of works
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Enclosure details size
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Respirator zone size
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Power / water needed
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Electrical isolation required
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Mechanical isolation required
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Gas / other isolation required
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Will the work area require clearing of materials / furniture etc prior to commencement of works? If yes by who
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Transit / waste route
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Will the transit route impact on others on site?
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If so how many? And what measures will be put in place?
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Sole control of Cordtape staff?
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Site specific photo
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DCU location
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Working area
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Airlock / Baglock
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Skip location/Wait and load
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Other
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Tools and equipment required
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Non asbestos hazards - work at height, confined spaces, unsafe structures, slips trips and falls, manual handling etc
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Any additional information
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Site layout drawing
