Asbestos Work Permit
Asbestos Management Program
Asbestos Work Permit
Appendix R
ASBESTOS W O R K P E R M I T
NOTICE: AH work shall conform to Federal, Provincial, Municipal standards, codes and guidelines
and the requirements set forth in the AMP for the PTSD or any project specifications prepared. In
the case of a conflict in any of the above noted documents, the most stringent shall apply.
P E R M I T NO.
Asbestos Work Request Originator
Contact
Telephone No.
Date of Request
Anticipated Start Date
Anticipated Completion Date
Work Site Location
Project Description
Work will be completed by:
•
PTSD trained Employees
Q Pre-Qualified Contractor
Specify Contractor
ASBESTOS PROCEDURES
Check all applicable
• Ceiling T iles
Q < 10 tiles in one location - Type 1
• > 10 tiles in one location - Type 2
•
• Type 1
• Type 2
Contaminated Space Entry (ceiling, crawlspace, shaft,
chase, etc.)
• Sheet Flooring
• Type 2
•
• Type 1
Floor Tiles
• Asbestos Cement Panels
• Type 1
• Type 3
•
•
•
•
•
Mechanical Insulation
Q Asbestos Debris Clean-up
Type 2 Removal
Type 2 Repair
Type 3
Glove Bag
• Type I
• Type 2
• Type 3
OTHER CONTROL FACTORS
•
Evening Work
Specify Hours:
•
Day Work
Specify Hours:
•
Weekend Work
Specify Hours:
•
Restricted Access to Work Area by Occupants
Specify Areas:
• Re-location of Occupants Required
Specify Area to be Relocated:
•
• Arrangements made for Inspections
Inspection and Air Monitoring Required
• HVAC Shut Down
Specify Hours and Zones:
• Other System Shut Down
Specify:
NOTIFICATION
• Notification Sent to:
© 2011 Pinchin Environmental Ltd.
•
•
•
•
Manitoba Workplace Safety and Health (for Type 3)
APO
Building Tenants
Department Head
Page 1
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