NHS - Surveyors Audit Form

• Conducted on

  Date

• Prepared by

• Location
  Address

• Auditor Name:

• Auditee Name:

• Company:

• Site Address:

• Survey Type:

  Refurbishment Survey

  Management

  Refurbishment to specified areas

• Date

  Date

Is equipment present, in good working condition, and clean?

• Sample bags

  Yes

  No

  N/A

• Knife

  Yes

  No

  N/A

• Chisel

  Yes

  No

  N/A

• Wipes

  Yes

  No

  N/A

• Screwdrivers (flat and cross head)

  Yes

  No

  N/A

• Core samplers

  Yes

  No

  N/A

• Tape / Paint / sealant

  Yes

  No

  N/A

• Flat nosed pliers

  Yes

  No

  N/A

• Barrier tape / signage

  Yes

  No

  N/A

• Overalls/Overshoes

  Yes

  No

  N/A

• RPE & filters

  Yes

  No

  N/A

• Waste bag

  Yes

  No

  N/A

• Drop sheet

  Yes

  No

  N/A

• Ladders (Tagged and in date)

  Yes

  No

  N/A

• H-type vac (in date)

  Yes

  No

  N/A

• Is the surveyor well presented, including uniform and ID?

  Yes

  No

  N/A

• Is the surveyor clean shaven?

  Yes

  No

  N/A

Survey

• Does the surveyor have a scope of work, signed risk assessment and method statement on site?

  Yes

  No

  N/A

• Are samples taken correctly and according to procedure? (i.e. sprayed down, tool decontaminated, sample point sealed, RPE worn, drop sheet used where required)

  Yes

  No

  N/A

• Is the surveyor working in a logical manor i.e. bottom to top – clockwise from the room entered?

  Yes

  No

  N/A

• Are sample bags labelled appropriately?

  Yes

  No

  N/A

• Is the surveyor checking all surfaces thoroughly? I.e. using a knife / chisel to inspect

  Yes

  No

  N/A

• Is survey data recorded with sufficient detail, including non-asbestos items? (consider presumed / strongly presumed samples)

  Yes

  No

  N/A

• For management surveys, are all easily accessible non-asbestos panels etc. inspected behind, including beneath floor coverings?

  Yes

  No

  N/A

• Have all areas of the building been accessed? If not, have no accesses been recorded correctly, with an appropriate reason as to why?

  Yes

  No

  N/A

• For refurb / demo surveys, are all non-asbestos materials accessed internally, including within boxing’s, behind panels, under floor boards etc.?

  Yes

  No

  N/A

• Is the surveyor aware of procedures in case of an emergency, including what to do on site, who to inform etc.?

  Yes

  No

  N/A

• Has the surveyor left the site in a safe condition without risk of injury to the building occupants upon completing the survey?

  Yes

  No

  N/A

• Is there any making good needed after the survey?

  Yes

  No

  N/A

• Are sufficient samples of ACM’s taken by the surveyor? (consider sample strategies for each material)

  Yes

  No

  N/A

• Is the surveyor qualified and authorised to carry out the survey? (this may have to be checked from the office)

  Yes

  No

  N/A

• Additional Comments:

Summary

• Overall Comments and Performance:

• Has the surveyor been informed of any issues / concerns?

  Yes

  No

  N/A

• Has the survey been carried out to a satisfactory level?

  Yes

  No

  N/A

• Has the surveying company been provided with a copy of this audit, including any issues?

  Yes

  No

  N/A

Site Layout – Include Room Names/numbers and Suspected ACM’s/Measurements

• Ground Floor photo

  Media

• First Floor photo

  Media

• Signature

  Sign