ZX-79 - Aviva Claims Services - Asbestos Stop Shift V.2:2019

• Site conducted

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• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Aviva Claims Services ~ ASBESTOS STOP SHIFT

Name of Supplier:

• undefined

Audit reference (Initials-YYYY-MM-NO):

• undefined

Supplier Operatives Names:

• undefined

Symbility Claim Ref:

• undefined

Task / activity:

• undefined

Number of Non-Compliant Issues:

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Commercial / Domestic Property:

• Commercial

• Domestic

Safety, Health & Environmental Procedural Checks

• Are there any issues with the site safety pack for the proposed works? <br>(is it available? Must include: site set up checklist; enclosure plan / drawing; Risk Assessment & Safe Systems of Works; CoSHH Assessments - has this been communicated and are works being undertaken in adherence to the site safety pack?)

  Yes

  No

  N/A

• Is there a copy of the HSE licence for visual inspection?<br>(In date? Enter the expiry date in comments section)

  Yes

  No

  N/A

• Are copies of the current employers and public liability insurance certification available?<br>(In date? Enter the expiry date in comments section)<br>

  Yes

  No

  N/A

• Is a copy of the company waste carriers licence available and copies of consignment notes ready to be completed for waste transfer?<br>(consignment notes must be completed before leaving site)<br>

  Yes

  No

  N/A

• Is there a copy of the ASB 5 notification form? <br>(Copy of the 14 day notification to remove licensed ACMs - if un-licensed ACMs use N/A) <br>

  Yes

  No

  N/A

• Is a site log present and being completed by the supervisor during removal?<br>(Or ready to use during removal stage)

  Yes

  No

  N/A

Site

• Is the van and decon unit parked in a suitable safe position not causing any obstructions? <br>(with enough room in the vehicle to remove waste produced from site)

  Yes

  No

  N/A

• Have the enclosure and air-locks been put up correctly, including fire extinguisher and warning notices? <br>(Fully sealed & as per site plan)

  Yes

  No

  N/A

• If working on electrics have these services been isolated by qualified / competent person and been left in a safe condition?<br>(Evidence of isolation competence must be viewed)

  Yes

  No

  N/A

• Is appropriate PPE supplied and being used? (Please clarify in comments section)

  Yes

  No

  N/A

• Is the works area clear of debris / trip hazards and adequately lit? (All reasonable steps taken - possible use of work lighting)<br>

  Yes

  No

  N/A

• Is adequate housekeeping maintained? (On site in general, not removal area - interior, exterior, floor protection, access areas etc)<br>

  Yes

  No

  N/A

• Are adequate first aid provisions available including eye wash? (must be easily accessible, adequately stocked and in-date)<br>

  Yes

  No

  N/A

• If any work-related accidents have occurred on site have they been reported according to procedure?<br>(Enter details of accidents / incidents and who / how they have been reported - If no accidents please choose N/A)

  Yes

  No

  N/A

• Do all operatives appear fit and capable of carrying out the works? <br>(Not suspected of being under the influence of drugs / alcohol)

  Yes

  No

  N/A

• Are the operatives ever supervised / monitored by their employer? (Suppliers must monitor employees and sub-contractors regularly)

  Yes

  No

  N/A

• Do all operatives on site carry an appropriate Company ID? (Please clarify in comments section)

  Yes

  No

  N/A

Equipment

• Is suitable Work at Height equipment in use and in good condition? <br>(Or on site ready to use - recent inspections displayed)

  Yes

  No

  N/A

• If there are any mechanical tools / plant being used on site, is it all PAT tested and in good working order?<br>(If no mechanical tools are being used, please choose 'N/A')

  Yes

  No

  N/A

• Is there a H-Vac inspection record present and up to date? (Documented evidence + evidence on the vacuum)

  Yes

  No

  N/A

• Is suitable RPE available / in use & are in date inspection records available? (Documented up to date evidence)

  Yes

  No

  N/A

• Is the NPU (Negative Pressure Unit) available / in use and is there an NPU Inspection Record present and up to date? <br>(Documented evidence in date & evidence on the unit)

  Yes

  No

  N/A

• Is a Decontamination Unit present and is the inspection record available and up to date? <br>(If De-con not available have provisions been made for wash down)

  Yes

  No

  N/A

Scope of Works

• Does the operative have a scope of works on site to include rooms and areas to be removed? (Full details of works required - should correlate to current revision works schedule)

  Yes

  No

  N/A

• Has the asbestos test sample been taken to the relevant areas correctly to obtain an accurate test result?<br>(sufficiently spread throughout an area, including freeze areas etc)

  Yes

  No

  N/A

Quality of Works

• Is the quality of work to an acceptable standard? (Operatives presentable, no un-necessary damage etc If not, why?)<br>

  Yes

  No

  N/A

• Works completed at your time of visit? (No score allocated to this question)

  Yes

  No

  N/A

ZERO tolerance

• Has a serious non-conformance been identified putting person/s 'At Risk' which has resulted in the work being suspended or deemed 'Safe' to continue working?

  Safe

  At Risk

  N/A

General summary of work / observations / good practices etc.

• undefined

Final Information

• Enter date / time

  Date

• Audit conducted by;

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