Contractors Asbestos Notification Form

NOTICE TO CONTRACTORS CONDUCTING WORK ACTIVITIES WITHIN WKU FACILITIES

Name of Contractor: ______

Name of Facility and Project: ______

Some materials in this building contain asbestos, a naturally occurring family of fibrous minerals, which for decades was widely used in commercial buildings as a fireproofing and insulating agent. Asbestos is closely regulated because airborne asbestos fibers may pose a serious health hazard, and proper procedures must be followed to prevent exposure. Airborne asbestos fibers may be released when asbestos-containing material is cut, sanded, painted, drilled or otherwise disturbed.

The work you will be performing may be around asbestos-containing material. Please observe the following special rules.

. Consult with your Project Manager concerning asbestos locations and concerns prior to work. . Do not remove pipe, joint, fitting, and valve or tank insulating materials without prior approval. . Do not remove or damage surfacing materials without prior approval. . Do not drill, sand, cut or grind floor tiles, gaskets or other resilient materials. . Do not damage floor tile while moving furniture or other objects. . Do not climb on or lean items such as ladders, equipments, or tools against insulated pipes, tanks or mechanical equipment.

Should you suspect that you or your workers have disturbed asbestos-containing material, stop work immediately and inform your project manager.

Be advised that any employee health and/or safety training, which may be required by EPA or OSHA, including asbestos awareness training, is the responsibility of the contractor. WKU is neither responsible nor liable for contractor non-compliance with the above-mentioned applicable regulations.

Please acknowledge your understanding of this Notice and your agreement to comply with the requirements of this Notice.

Contractors Representation: ______

Signature: ______Date: ______

WKU Project Manager Signature: ______Date: ______

(Note: The contractor is responsible for returning one completed copy to the Project manager. Project Manager is responsible for returning the completed copy to the WKU Asbestos Program Liaison prior to commencement of work by contractor.)

WKU EH&S Asbestos Liaison: ______Date: ______

7/2004