Title Page

  • Document No.

  • Site title

  • ACM

  • Prepared by

  • Branch

  • Contract Manager

  • Conducted on

  • 1.1 Is the plan of work of a good enough standard to proceed and does it reflect the site conditions? (Licensed works, ASB5 attached)

  • Comments:

  • If answer is NO, send photo ammendments

  • Amendments Comments:

  • 1.2 Have all site staff been briefed on the contents of the plan of work and informed of risks?

  • Comments:

  • Photo of Paperwork:

  • 1.3 Have other contractors based at this site been briefed on the work?

  • Comments:

  • Photo of Paperwork:

  • 1.4 Do you have copies or access to all of the following documentation? Internal Training certs, Specialist Training certs, Face Fits, 6 Mthly Respirator certs, Mthly Mask checks, Medical certs, Equipment certs

  • Comments:

  • Photo:

  • 1.5 Is the DCU in the best position, operational and in good working order and has: All certs up to date, EZplug, CO2 Alarm, Bull Bar/Wheel Lock, Good Earth and Clean Water filter.

  • Comments :

  • Photo of DCU:

  • 1.6 Is the access(entry) to and egress (exit) from work areas(s), including routes (Transit/Waste) clearly signed with Shield signage and free from debris. Potential hazards marked with hazard tape and controlled areas cordoned off with barrier tape?

  • Comments:

  • Photo of routes

  • 1.7 Does the site board contain the following items: valid Insurance cert & Asbestos License, Waste Carrier License, Site Documentation, Fire Extinguisher, First aid kit, Air horn, Supervisor name & Contact No.

  • Comments :

  • Photo of Board:

  • 1.8 Are the following safety warning signs, as well as barrier tape identifying the asbestos and respirator zones, in place? No Unauthorised Access, Wear RPE, Wear Coveralls, Danger Asbestos

  • Comments :

  • Photo of Signage:

  • 1.9 Has the access equipment been set up correctly, filling in the relevant checklist or risk assessment if necessary? Signatory must have valid training: PASMA for access Tower, IPAF for MEWP, Fixed scaffold: Fit for purpose and Scaff tagged, Confined Space or Restricted access: Assessed and qualified

  • Comments :

  • Photo of Paperwork &Equipment:

  • 1.10 If an external contractor has set up the equipment, do you have copies of the necessary certs?

  • Comments :

  • Photo of certs:

  • 1.11 Has the gas been purged, electrical equipment and lighting been isolated? Do you have copies of the certs?

  • Comments :

  • Photo of certs:

  • 1.12 Has all RPE been checked and has the check sheet been completed?

  • Comments :

  • Photo of Paperwork:

  • 1.13 Are all personnel expected to wear RPE clean shaven? Supervisor, Operatives, Visitors; ie Analyst.

  • Comments :

  • Photo:

  • 1.14 Are all personnel wearing the correct PPE?

  • Comments :

  • Photo:

  • 1.15 Have all points on the daily inspection sheet been checked and sheet completed?

  • Comments:

  • Photo:

  • Name of Supervisor:

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