Permit to Work - Working with Asbestos v2

• Conducted on

  Date

• Prepared by

• Location
  Address

• This should be read in conjunction with this permit as the Asbestos Removal Control Plan (ARCP) provides all relevant regulation and legislative detail required for completing asbestos work.

• Has a Asbestos Removal Control Plan (ARCP) been submitted, reviewed and accepted as complete and meeting regulations, the Approved Codes of Practice and the Universities requirements?

  Yes

  No

  N/A

• Is there an accompanying SSSP or Risk Assessment/s?

  Yes

  No

  N/A

• Has a WorkSafe notification been received and sighted?

  Yes

  No

  N/A

• Have you consulted the Site Asbestos Register for the work location?

  Yes

  No

  N/A

This Permit is only Valid when all sections are complete. If you are in doubt or don't understand, then please ask. Remember, all accidents are preventable and it is people who get hurt and suffer pain. Please use this permit in the spirit intended to protect yourself and others. Please ensure that you sign this permit to work. DO NOT PROCEED WITH YOUR WORK UNTIL YOUR PERMIT HAS BEEN AUTHORISED BY THE RELEVANT MEMBER OF STAFF.

• Brief description of works being undertaken?

• Any additional special tools or equipment to be used over the period of the work?

• Has the work identified if it will be Asbestos Related Work or Asbestos Removal Work?

• Is any other work currently being undertaken that may interact or affect this permit, such as Working at Height or Hot Works?

All Work Type Requirements

• Is the Asbestos Removal Control Plan (ARCP) onsite and known to workers?

  Yes

  No

  N/A

• Is the work being undertaken Class A related?

  Yes

  No

  N/A

• Is the work being undertaken Class B related?

  Yes

  No

  N/A

• Is air monitoring in place?

  Yes

  No

  N/A

• Do all licensed workers have their asbestos qualification cards on site?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Licensed Asbestos Removal - Licensed Work can only be undertaken by an approved WorkSafe Licensed Contractor. ******STOP WORK IF LICENSE IS NOT PRESENT ON SITE******

  Yes

  No

  N/A

• Does the work being conducted fall under 10 square metres?

  Yes

  No

  N/A

• Will an enclosure be used for this work and has this been smoke or pressure tested prior to work starting?

  Yes

  No

  N/A

• Are all workers onsite Asbestos Awareness Trained?

  Yes

  No

  N/A

• Do you have the equipment required in the Asbestos Essentials Method Statement? i.e. H Rated Vacuum Cleaner / Dust Extraction Equipment.

  Yes

  No

  N/A

• Do all workers have correct Personal Protective Equipment (PPE) as detailed in the Asbestos Removal Control Plan (ARCP) ?

  Yes

  No

  N/A

• Have all employees been trained in selection, fitting, decontamination and safe removal of Personal Protective Equipment (PPE)? <br> ** NB: If NO - Work is not Permitted as Mask will not provide protection **

  Yes

  No

  N/A

• Are all employees using Respiratory Protective Equipment (RPE) clean shaven?

  Yes

  No

  N/A

• Has a decontamination area been set up for workers and equipment?

  Yes

  No

  N/A

• Is a comprehensive asbestos waste process in place onsite and managed by a designated worker?

  Yes

  No

  N/A

• Is the Emergency Response Plan and Procedure known and displayed on site?

  Yes

  No

  N/A

• Unlicensed Asbestos Removal

  Yes

  No

  N/A

• Does the work being conducted fall under 10 square metres?

  Yes

  No

  N/A

• Are you Asbestos Awareness Trained?

  Yes

  No

  N/A

• Do you have the equipment required in the Asbestos Essentials Method Statement? i.e. H Rated Vacuum Cleaner / Dust Extraction Equipment.

  Yes

  No

  N/A

• Do all workers have correct Personal Protective Equipment (PPE) as detailed in the Asbestos Removal Control Plan (ARCP) ?

  Yes

  No

  N/A

• Have all employees been trained in selection, fitting, decontamination and safe removal of Personal Protective Equipment (PPE)? <br> ** NB: If NO - Work is not Permitted as Mask will not provide protection **

  Yes

  No

  N/A

• Are all employees using Respiratory Protective Equipment (RPE) clean shaven?

  Yes

  No

  N/A

• Is a comprehensive asbestos waste process in place onsite and managed by a designated worker?

  Yes

  No

  N/A

• Is the Emergency Response Plan and Procedure known and displayed on site?

  Yes

  No

  N/A

Contractor Section

• Person in Charge of Works

• Company

• Signature

  Sign

Permit Issuer

• Name of Permit Issuer

• Signature of Permit Issuer

  Sign

Permit Period

• Permit Issued on

  Date

• Permit Expires on

  Date

• Company Undertaking Air Clearance Test

• Name of Person Undertaking Air Clearance Test

• Air Clearance Result (WEL is 1 Asbestos Fibre /m3 Air)

• Work Area is safe for persons to enter as Work Exposure Levels have not been exceeded?

  Safe

  At Risk

  N/A