Requested By
*
Company
*
Contact Number
*
Contact Email
*
Signature
*
Description of works and location on site
*
Contact name during works
*
Contact number during works
*
Company undertaking asbestos removal works
*
Asbestos Contractor SafeWork NSW Licence Number
*
Asbestos Contractor ABN
*
Asbestos Contractor contact name
*
Asbestos Contractor contact number
*
Type of asbestos
*
Friable
Non-Friable
Amount of asbestos to be removed (square metres)
*
Has an Asbestos Removal Control Plan been prepared?
*
Yes
No
Who will undertake asbestos works notifications for workers and impacted residents/businesses?
*
When will this notification occur?
*
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)
*
Licensed Asbestos Assessor ABN
*
Licensed Asbestos Assessor contact name
*
LIcensed Asbestos Assessor contact number
*
Are works being undertaken on a construction site?
*
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?
*
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?
*
Yes
No
Is the principal contractor satisfied with the SWMS?
*
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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