METHOD STATEMENT CHECKLISTControl of Asbestos at Work Regulations 2002 & L27 LAB REF:

CLIENT: CLIENT REF: COPY TO: E. ROBSON

TYPE: METHODCHECK DATE TAKEN: TAKEN BY:

SITE NAME: SAMPLE POINT:

TMS CODE: CBR NUMBER: PLAN DATE:

OVERALL ASSESSMENT METHOD STATEMENTNo issues to resolve AcceptableIssues noted which have been resolved Improvement requiredSignificant issues requiring formal action Substantial improvement required

Signature Print Name

REMOVAL CONTRACTOR: ………………………………….…………………DATE OF REVIEW:…………...……..DATE OF RECEIPT OF METHOD STATEMENT: ………….. PROPOSED START DATE OF WORKS: …………….The following is a summary of the elements which should be considered in a method statement for removal of asbestos insulation or coating. Further information may be found in the relevant Codes of Practice and Guidance Notes. Each job must be considered individually.

1 Details of contract: YES NO N/AStated version company's standard procedures which apply

name and address of the persons to whom you are contracted

Names and telephone numbers of all relevant contacts including supervisor

When the supervisor will be on site

name of the competent person preparing the plan of work

The number of employees on the job at any time

When the work is going to take place ie dates and times (nights, week end work, etc),

The dates for set up, removal and clearance.

The names of the principal contractor, the planning supervisor and CDM client, if CDM applies

The name(s) of any other asbestos licence holders involved

Name of the analyst who will carry out the 4 stages of the clearance process (Hampshire Scientific Service will undertake these)

2 Scope of work and risk assessment:Provide a description of the work, its location and the removal method details of any asbestos survey, the level (Type 1, 2 or 3)

Type and form of asbestos, the quantity, extent and condition

Provide brief details of any access and fire risks and precautions taken

Who will consider departures from the Plan of Work and how will these be noted and recorded on site?

3 Control measures:Expected exposure using controls specified

Issue date: June 2006 Authorised by: NW Form/issue no: 567/09

Description of the steps taken to reduce exposure as low as reasonably practicable and to control release into the environment

sketch(es) showing size of enclosure(s), location of viewing panels, negative pressure units, H-type vacuum cleaners, DCU, transit routes, bag locks, waste routes, skips etc, and include the positions from which the water and electrical supplies to the DCU are to be fed

volume of enclosure

size and numbers of NPU s and number of air changes per hour.

type of respirators used

Description of the air monitoring arrangements for duration of the work (not undertaken by HSS)

Description of the arrangements for smoke testing and witnessing.

Description of how control measures are to be maintained on site and what checks are to be in place

4 Method of work for removal:Any additional precautions to reduce exposure

Provide detailed site information and a site specific description of the working method to be used with reasons

Fibre suppressant technique being used For wet strip - injection technique, time allowed for penetration, how will they check material is fully saturated

What tools and other equipment are to be used

For AIS work, provide a proper indication of practical measures to minimise dust release

5 Other site specific information: not in company procedures and relating to:DCUs

Entry and exit procedures

Welfare facilities

Waste disposal

Emergency procedures (including asbestos disturbance during enclosure erection, etc)

Documentation required on site

Visitors and control of access

Any additional Client’s requirements

Work on live electrical or steam plant

Absence of lighting

Work at elevated heights

Floor sheeting required

Issue date: June 2006 Authorised by: NW Form/issue no: 567/09

Current ABR & Visio plans available

Issue date: June 2006 Authorised by: NW Form/issue no: 567/09