Title Page

  • Conducted on

  • Prepared by

Licensed Contractor : Squibb group limited . Address : Squibb House , Stanhope Industrial Estate , Stanford-le-Hope .

  • Job number

  • Removal Site Address :

  • Location of enclosure ? .

  • Size of enclosure? ( see POW ) ( L x W x H ( metres ))

  • Has full access of the site been obtained ? .

  • Has a new pre-filter been installed in the NPU’s ? .

  • Have all ACM removal locations been checked and certified as free from asbestos ? .

  • Have all floor surfaces / walls / items been inspected and confirmed as visually clean ? .

  • Have all ledges , sills , higher level surfaces ( including scaffolding and large waste items ) been checked and confirmed as visually clean ? .

How long did the supervisors visual inspection take ? .

  • Start time :

  • Finish time :

  • Total time : Hours / minutes

I certify that I have carried out a thorough visual inspection of the enclosure / work area and can confirm that the area is visually clean and ready to be made available to the Analyst for the independent 4-stage clearance

  • Supervisors signature .

  • Date & Time

Form to be handed to the Analyst before 4-stage clearance starts :

  • Analyst signature .

  • Date & Time

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