Requested By
*
Company
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Contact Number
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Contact Email
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Signature
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Description of works and location on site
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Contact name during works
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Contact number during works
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Company undertaking asbestos removal works
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Asbestos Contractor SafeWork NSW Licence Number
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Asbestos Contractor ABN
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Asbestos Contractor contact name
*
Asbestos Contractor contact number
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Type of asbestos
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Friable
Non-Friable
Amount of asbestos to be removed (square metres)
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Has an Asbestos Removal Control Plan been prepared?
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Yes
No
Who will undertake asbestos works notifications for workers and impacted residents/businesses?
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When will this notification occur?
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Has a suitably qualified Licensed Asbestos Assessor been engaged to undertake air monitoring, clearance inspections and certificates?
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Yes
No
Licensed Asbestos Assessor (Business Name)
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Licensed Asbestos Assessor ABN
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Licensed Asbestos Assessor contact name
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LIcensed Asbestos Assessor contact number
*
Are works being undertaken on a construction site?
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Yes
No
Principal Contractor and ABN
*
Has an Asbestos Removal Control Plan been prepared and provided to the Principal Contractor?
*
Is the principal contractor satisfied with the ARCP?
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Yes
No
Has a copy of the Asbestos Contractor SafeWork NSW License been provided to the principal contractor?
*
Yes
No
Has a copy of the Asbestos Contractor SWMSs been provided to the principal contractor?
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Yes
No
Is the principal contractor satisfied with the SWMS?
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Yes
No
Copy of the Asbestos Contractor SafeWork NSW Licence
*
×
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Upload relevant qualifications, licenses and training for workers undertaking asbestos removal works’
*
×
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Asbestos Removal Control Plan
*
×
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Asbestos Contractors SWMS
*
×
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Submit
Email