St Mungos Annual Asbestos inspection R1

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Asbestos Material Inspection

Asbestos Material Location

• Location of Asbestos Material

• Date of Inspection

  Date

• Asbestos Type

  Select Chrysotile Amosite Crocidolite Tremolite Anthophyllite Actinolite Presumed

  • Chrysotile
  • Amosite
  • Crocidolite
  • Tremolite
  • Anthophyllite
  • Actinolite
  • Presumed

• Image of Asbestos Material

  Media

• Has the identified material been disturbed in any way?

  Yes

  No

  N/A

• Is the ACM material suitably identified with correct labeling?

  Yes

  No - Tenant Refused labelling

  No - Unable to access safely

  No - Others please specify

• Is the surface of the material broken, frayed or scratched?

  Yes

  No

  N/A

• Is the material completely attached to its base/support as per original construction?

  Yes

  No

  N/A

• Are the surface sealants peeling or scratched?

  Yes

  No

  N/A

• Are all protective coverings designed to protect the material in place and free from damage

  Yes

  No

  N/A

• Is there any evidence of any particles of dust from the material in the area?

  Yes

  No

  N/A

• Overall is there sufficient evidence of material failure of asbestos product that would warrant a removal plan?

  Yes

  No

  N/A

• Provide recommendation and instruction to Client to maintain safe systems in preparation of removal.

Attendance Signatures

• Property Services Representative Signature

  Sign