<p> LAB REF:</p><p>SAMPLE TYPE: SITE INSPECTION ASBESTOS – BEFORE REMOVAL</p><p>CLIENT: CLIENT REF: COPY TO: E. Robson</p><p>UNIT: ASBESTOS DATE TAKEN: TAKEN BY: CEF NUMBER:</p><p>SITE NAME: TMS CODE:</p><p>SAMPLE POINT: PLAN DATE:</p><p>CBR NUMBER: TRAVEL/ON-SITE TIME:</p><p>Asbestos Contractor: ..…………………………………………………….. Tel: ……………………… Supervising Contractor: ………………………………………………... Tel: ……………………… Operatives on site:………………………………………………………………………………………. Estimation of Work Area Size: …………………………………………………………………………. Brief Description of Works: ……………………………………………………………………………. ……………………………………………………………………………………………………………</p><p>Site Checks Prior to Works:  /  Contractors Licence to Work on Site ? Medical Certificate for Contractors on Site ? Appropriate Equipment With Test Certification Present ? PPE Present with Appropriate Certification ? Method Statement Present and Unaltered ? Enclosure Present Showing Good Integrity ? Covering of Equipment Within Enclosure Satisfactory ? 3 – Stage Airlock Present ? Primary Decontamination Facilities Present ? Hazard Warning Signs Present ? Satisfactory Negative Pressure Unit ? Negative Pressure Visually Observed ? Flow Rate Measured Across Face of Negative Pressure Unit (m/s) Satisfactory Smoke Test ? Volume Flow Satisfactory (see over) ? Suitable Decontamination Unit (Connected, Warning Signs, Cleanliness, Position, Operational) ? Waste Disposal Facilities Present (Position, Lockable) ? Polythene Thickness Satisfactory (see over) ?</p><p>Additional Comments: ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………… ……………………………………………………</p><p>OVERALL ASSESSMENT No issues to resolve Acceptable Issues noted which have been resolved Improvement required Significant issues requiring formal action Substantial improvement required</p><p>Signature Print Name</p><p>Issue Date: July 2005 Authorised by: NW Form/issue no: 57/08 Page 1 of 2 PLAN OF ENCLOSURE AND SURROUNDING AREA:</p><p>Equipment Inventory Numbers: Polythene Thickness Measurements (Micrometer Units): Rotary Vane Anemometer: Micrometer: Tape Measure: Average Polythene Thickness (Micrometer Units):</p><p>CALCULATIONS: Area of Circle = πr2 </p><p>Volume Flow: Cross Sectional Estimated Volume Flow = Area of NPU Outlet X Mean Face Velocity (M 3/S) (M2) (M/S)</p><p>Estimation of Enclosure = Estimated Length X Estimated Width X Estimated Height Volume (M3) of Enclosure (M) of Enclosure (M) of Enclosure (M)</p><p>100M 3 Estimated Volume Estimated Volume Flow (M 3/S) X Estimation of Flow Per 100 M3 = Enclosure Volume 3 3 3 M /S / 100M (M )</p><p>Minimum Volume Flow = >0.1 M 3/S Per 100M3 (Area of a circle = r2)</p><p>Polythene Thickness:</p><p>Average thickness of polythene (m) = Micrometer units X 10 microns (m)</p><p>1000 gauge  250 microns (m)  25 micrometer divisions 500 gauge  125 microns (m)  12.5 micrometer divisions</p><p>Measurements recorded up to 10% below specified gauge can be accepted.</p><p>Issue Date: July 2005 Authorised by: NW Form/issue no: 57/08 Page 2 of 2</p>