Information
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Name of Supervisor
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Name of Assessor
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Project Number
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Date
Assessment - Supervisor
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The following assessment shall be completed by a person authorised by the Managing Director to do so. The assessor should include direct reference to documentation witnessed during the assessment and ensure a photographic record is made of relevant witnessed activities.
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Scoring criteria / guidance
0 - Individual shows no compliance against the criteria and should be prohibited from working with asbestos until retrained and reassessed
1 - Individual demonstrates some knowledge and understanding but requires retraining in this element
3 - Individual demonstrates sufficient knowledge, skill and understanding to perform their allocated duties
5 - Individual demonstrates a good level of knowledge, skill and understanding of their allocated duties -
Brief description of the works being undertaken during the assessment
Assessment Modules 1 - 10
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1 - Plan of work
Assessment criteria;
The work is properly planned and executed. This achieved by;
• Undertaking the asbestos works in accordance with the plan of work
• Controlling the work activities
• Monitoring and recording work activities
Core Modules applicable from HSG 247;
modules 1, 2, 3, 15, 17 & 18 -
Assessed?
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Summary of evidence
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2 - PPE & RPE
Assessment criteria;
Personal & respiratory protective equipment is effectively used. This achieved by;
• Inspecting and testing RPE/PPE, recording the findings of these inspections and reporting any faults
• Correctly wearing RPE/PPE
• Cleaning, storing and charging of RPE/PPE
• Monitoring site practices to ensure that the correct procedures are followed
Core Modules applicable from HSG 247;
modules 6 & 7 -
Assessed?
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Summary of evidence
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3 - Site set-up, maintenance, dismantling & Fault Finding
Assessment criteria;
A safe and secure site is set-up in accordance with the POW to enable asbestos works to be carried out safely by;
• Reviewing site conditions against the plan of work
• Carrying out the site team briefing
• Setting up and checking functionality of the DCU and welfare facilities
• Ensuing all necessary pre-cleaning is completed (if necessary)
• Establishing and maintaining the site and any necessary containment
• Monitoring individuals to ensure the site set-up is n accordance with the plan of work
Core Modules applicable from HSG 247;
Modules 4 & 14 -
Assessed?
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Summary of evidence
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Photographs taken?
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4 - Controlled stripping techniques
Assessment criteria;
Exposure to asbestos is minimised by;
• Following the work methods stated within the POW
• Using the correct methods and equipment for fibre / dust suppression
• Inspecting and maintaining control measures, recording the findings and reporting any faults
• Monitoring the works to ensure the control measures are properly implemented and remain effective
Core Modules applicable from HSG 247;
Modules 5 -
Assessed?
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Summary of evidence
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5 - Plant & Equipment
Assessment criteria;
Plant and equipment is inspected, set-up and used in accordance with the POW by;
• Inspecting and testing plant and equipment, recording the findings of these inspections and reporting any faults
• Using the plant and equipment correctly and in accordance with the POW
• Cleaning, maintaining and storing plant and equipment
Core Modules applicable from HSG 247;
Modules 10 & 16 -
Assessed?
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Summary of evidence
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6 - Decontamination & Transit Procedures
Assessment criteria;
Effective decontamination of people, premises and plant is achieved by;
• Use of correct decontamination procedures for personal decontamination
• Using the correct decontamination procedure for plant and equipment
• Using the correct decontamination procedures for premises
• Monitoring transit and decontamination procedures to ensure they are implemented and effective
Core Modules applicable from HSG 247;
Modules 8 -
Assessed?
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Summary of evidence
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Photographs taken?
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7 - Cleaning & Clearance procedures
Assessment criteria;
Cleaning and procedures for establishing safe reoccupation are achieved by;
• Using the correct decontamination procedures for premises
• Undertaking and recording inspections of the work area at key stages and prior to inviting the analyst to commence the 4-stage clearance procedure
• Assisting the appointed analytical contractor in the 4-stage clearance procedure
Core Modules applicable from HSG 247;
Modules 9 & 16 -
Assessed?
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Summary of evidence
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8 - Emergency Procedures
Assessment criteria;
Suitable arrangement for dealing with emergency situations are achieved by;
• Demonstrate undertaking emergency arrangements for loss of electrical power, fire, first aid, failure of equipment / RPE
Core Modules applicable from HSG 247;
Modules 12 -
Assessed?
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Summary of evidence
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9 - Waste Management & Disposal
Assessment criteria;
Waste materials are packaged, handled and disposed of by;
• Use of correct waste bagging techniques
• use of appropriate waste handling and transfer procedures
• Demonstrate correct waste handling and disposal
Core Modules applicable from HSG 247;
Modules 11 & 16 -
Assessed?
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Summary of evidence
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Photographs taken?
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10 - Non-asbestos hazards
Assessment criteria;
Non-asbestos hazards are identified and controlled by;
• Demonstrate hazard identification
• Control site activities to ensure significant hazards are identified and properly assessed prior to commencing works
• Describe and where appropriate establish control measures to reduce risks to an acceptable level
Core Modules applicable from HSG 247;
Modules 13 & 18 -
Assessed?
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Summary of evidence
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Summary of assessment (include any additional information that could be used to assess the operative or identify any additional training needs.
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Signature of Supervisor
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Signature of Assessor
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Assessment review by
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Score entered on to CMS database?
