Cordtape Site Assessment Form Checklist

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