SSF 032 NNLW Exposure Record

• Job Number

• Site

  Select

• Conducted on

  Date

• Site Supervisor

• Location
  Address

• Name of Operative

• Type of Material

  Floor Tiles

  Textured Coatings

  Asbestos Cement

• Type of Asbestos

  Select Chrysotile (white) Amosite (brown) Crocidolite (blue)

  • Chrysotile (white)
  • Amosite (brown)
  • Crocidolite (blue)

• The mask is not in appropriate condition, it must not be used and should be returned to Head Office for replacement.

• Confirm Half-Mask Was Worn

• Times in and out of Asbestos Work Area

• Time In

  Date

• Time Out

  Date

• Time In

  Date

• Time Out

  Date

• Time In

  Date

• Time Out

  Date

• Daily Exposure Hours

• Fibre Level

• Daily Exposure Total

• Name & Signature of Operative

  Sign

Site Supervisor Sign-off

• Add signature

  Sign

• C. G. Comley & Sons Limited T/A Comley Demolition. Registered office: Southern Way, Rye Common, Odiham, Hook, Hampshire, RG29 1HU. Telephone: 01256 702178. Email: comley@comleydemolition.co.uk Company Registration Number: 01672195