Asbestos Permit to Work

Transcription

1 Asbestos Permit to Work This permit to work is issued to the named person only. NO other work other than that detailed must be carried out. IMPORTANT MESSAGE This Permit to Work has been created from an asbestos Management Survey. If the works detailed on page 2 involve opening up hidden cavities (for example but not limited to ceiling voids, cavity walls, service ducts etc.) then further investigative works will be required involving an asbestos Refurbishment and Demolition survey. Actual work involving licensed asbestos containing materials will only be carried out by a licensed asbestos removal contractor with a Plan of Work and the appropriate control measures in place. Non licensed asbestos containing materials can be worked upon providing HSE guidelines are followed and the operatives have a minimum of Asbestos Awareness Training Category B certification. One Copy for Office Duplicate copy to contractor Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 1 of 15

2 Asbestos Permit To Work Permit Number: 7 Permit Date: 29/01/2016 Contracting Company: Bryan G Responsible person from Bryan G: Wills and Scope of Work Warehouse, replacement of light fittings Permit Valid From 01/02/ :00 Permit Valid Until 01/02/ :00 Has The Asbestos Register Been Viewed By The Contractors Responsible Person (Please note the important message on the first page of this Permit to Work) Will The Works Disturb Any Known Asbestos Containing Material YES YES What Asbestos Awareness Training Category Do They Have Category B Have They Been Checked YES Has a Method Statement Been Approved YES Has A Risk Assessment Been Approved YES Declaration of Works to be Completed Work that will not disturb known asbestos I acknowledge that I/we have examined the asbestos report in relation to the proposed area of work as defined by Bryan G and that the work activities will not displace the asbestos materials. I hereby declare that no work other than that stated above will be carried out, and all precautionary measures will be adhered to: Work that will disturb known asbestos I acknowledge that I/we have examined the asbestos report in relation to the proposed area of work as defined by Bryan G and that the work activities will displace the asbestos materials. I hereby declare that any works that displace the asbestos materials will be completed in accordance with the asbestos regulations and all precautionary measures will be adhered to: Please Tick Please Tick Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 2 of 15

3 Contractor Name: Wills Company: Bryan G Position: H & S Signature: Time: Date: Authorisation to Proceed Name: Paul Thomson Signature: Position: H & S Time: Date: Clearance by Contractor Work that has not disturbed known asbestos I hereby declare that the work stated above has/has not* been completed and the asbestos described in the asbestos register has not been disturbed. Work that has disturbed known asbestos I hereby declare that the work stated above has/has not* been completed and the asbestos described in the asbestos register has been disturbed. (Please complete the clearance documents section) Name: Company: Please Tick Please Tick Position: Time: Date: Signature: Clearance Documents Has All Removed Asbestos Been Cleared From Site Has an Air Test Been Completed and Left on Site Has a Consignment Note Been Left on Site Has the Area Been Inspected Prior to Sign Off Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 3 of 15

4 Sign Off Name: Signature: Company: Position: Time: Date: Cancellation of Work Permit All copies of this permit to work are heby cancelled: Name: Position: Date: Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 4 of 15

5 Appendix A. Data Sheets The above risk assessment methodology has been incorporated in the data sheets. The data sheets provide recommendations from the surveyor concerning remedial measures that should be adopted at each sample location. Where appropriate, they also provide an opinion concerning the likely source of any surface deposits of asbestos dust or debris that are present. It is important that the data sheets are read in conjunction with the plans and the following colour code is followed. Laboratory analysis shows that asbestos is not present in the recovered sample. Laboratory analysis shows that asbestos is present in the recovered sample. No laboratory analysis has been carried out because it was not possible to recover a sample due to either logistical or health and safety reasons. It is considered likely that asbestos is present. Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 5 of 15

6 Sample Number 027 Sampled G-17 W.C Asbestos Type Chrysotile Product Type Gasket Good Surface Treatment Composite Materials Material Risk Score 2 Occupant Activity Rare Disturbance Unlikely to be disturbed No. of Occupants None Maintenance Not Applicable Extent/Amount Small amounts or items s up to 100 m2 Frequency of Use Not Applicable N/A Total Risk Score 2 Non Licensed Next Inspection Not Applicable Image for Sample 027 The bitumen adhesive only to the back of the orange floor tiles, which is consistent with other backing adhesive in room G-12 & G-13, contains Chrysotile asbestos. It is recommended that the condition of this product is monitored via a Management Plan on an annual basis CHRYSOTILE WAS DETECTED IN THIS SAMPLE Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 6 of 15

7 Sample Number 033 Sampled G-17 W.C Ceiling Asbestos Type Chrysotile Product Type Textured Coating Good Surface Treatment Cement Material Risk Score 3 Occupant Activity Low Disturbance Occasionally disturbed No. of Occupants 1-3 Maintenance Low Disturbance Extent/Amount >10 m2 to <=50 m2/pipe run s up to 100 m2 Frequency of Use Daily 4 Total Risk Score 7 Image for Sample 033 This textured coating contains Chrysotile asbestos. It is recommended that the condition of this product is monitored via a Management Plan on an annual basis. Next Inspection Non Licensed Not Applicable CHRYSOTILE WAS DETECTED IN THIS SAMPLE Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 7 of 15

8 Sample Number 039 Sampled G-16 Warehouse Ceiling Void Asbestos Type Chrysotile Product Type Loose Insulation High Damage Surface Treatment Fabric Material Risk Score 8 Occupant Activity Rare Disturbance Unlikely to be disturbed No. of Occupants None Maintenance Rare Disturbance Extent/Amount >50 m2 or >50 m pipe run Confined Spaces Frequency of Use Infrequently 2 Total Risk Score 10 Licensed Next Inspection Not Applicable Image for Sample 039 This loose insulation, which is potentially consistent with all loose insulation in roofs #2, #3 and #4, contains Chrysotile asbestos. This is a notifiable non licensed product. It is recommended that the small damaged area is repaired, and then the condition of this product is monitored via a Management Plan on an annual basis. CHRYSOTILE WAS DETECTED IN THIS SAMPLE Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 8 of 15

9 Sample Number 040 Sampled G-16 Warehouse Ceiling Void Asbestos Type Chrysotile Product Type Debris - Non Licensed High Damage Surface Treatment Fabric Material Risk Score 6 Occupant Activity Rare Disturbance Unlikely to be disturbed No. of Occupants None Maintenance Rare Disturbance Extent/Amount >50 m2 or >50 m pipe run Confined Spaces Frequency of Use Infrequently 2 Total Risk Score 8 Notifiable Non Licensed Next Inspection Not Applicable Image for Sample 040 This loose insulation, which is potentially consistent with all loose insulation in roofs #2, #3 and #4, contains Chrysotile asbestos. This is a notifiable non licensed product. It is recommended that the small damaged area is repaired, and then the condition of this product is monitored via a Management Plan on an annual basis. CHRYSOTILE WAS DETECTED IN THIS SAMPLE Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 9 of 15

10 Sample Number 047 Sampled External Asbestos Type Chrysotile Product Type Debris - Non Licensed High Damage Surface Treatment Cement Material Risk Score 6 Occupant Activity Rare Disturbance Unlikely to be disturbed No. of Occupants None Maintenance Rare Disturbance Extent/Amount <=10 m2 or <=10 m pipe run Outdoors Frequency of Use Infrequently N/A Total Risk Score 6 Notifiable Non Licensed Next Inspection 22/04/2016 Image for Sample 047 This asbestos cement pipe remains in situ. This should be removed as soon as possible. A consignment note should be obtained and uploaded to the management system. Please ensure the person removing the asbestos has a minimum Category B Asbestos Awareness Training Certificate which should also be uploaded to the management system. CHRYSOTILE WAS DETECTED IN THIS SAMPLE Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 10 of 15

11 No Sample Taken NST004 Presumed G-16 Warehouse Wall Asbestos Type Amosite Product Type Fuse Holder Good Surface Treatment AIB (sealed) Material Risk Score 4 Occupant Activity Rare Disturbance Unlikely to be disturbed No. of Occupants None Maintenance Low Disturbance Extent/Amount Small amounts or items s up to 100 m2 Frequency of Use Infrequently 1 Total Risk Score 5 Non Licensed Next Inspection Not Applicable Image for Sample NST004 There is presumed to be asbestos in electrical switch boxes. Access, however, is not practical during an Asbestos Management Survey. It is recommended that the condition of this product is monitored via a Management Plan on an annual basis. ASBESTOS WAS PRESUMED TO BE IN THIS SAMPLE Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 11 of 15

12 No Sample Taken NST005 Presumed G-16 Warehouse Wall Asbestos Type Amosite Product Type Electrical Heater Good Surface Treatment AIB (sealed) Material Risk Score 4 Occupant Activity Rare Disturbance Unlikely to be disturbed No. of Occupants None Maintenance Low Disturbance Extent/Amount Small amounts or items s up to 100 m2 Frequency of Use Infrequently 1 Total Risk Score 5 Non Licensed Next Inspection Not Applicable Image for Sample NST005 This heater is at high level. There is presumed to be asbestos in all heat generating equipment. Access, however, is not practical during an Asbestos Management survey. It is recommended that the condition of this product is monitored via a Management Plan on an annual basis. ASBESTOS WAS PRESUMED TO BE IN THIS SAMPLE Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 12 of 15

13 No Sample Taken NST006 Presumed G-16 Warehouse Wall Asbestos Type Amosite Product Type Electrical Heater Good Surface Treatment AIB (sealed) Material Risk Score 4 Occupant Activity Rare Disturbance Unlikely to be disturbed No. of Occupants None Maintenance Low Disturbance Extent/Amount Small amounts or items s up to 100 m2 Frequency of Use Infrequently 1 Total Risk Score 5 Non Licensed Next Inspection Not Applicable Image for Sample NST006 This heater is at high level. There is presumed to be asbestos in all heat generating equipment. Access, however, is not practical during an Asbestos Management survey. It is recommended that the condition of this product is monitored via a Management Plan on an annual basis. ASBESTOS WAS PRESUMED TO BE IN THIS SAMPLE Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 13 of 15

14 Appendix B. Site Plans with Sample s Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 14 of 15

15 Asbestos Permit to Work Created by Amosite, Asbestos Management on Site Page 15 of 15