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Asbestos Abatement Guidelines and Policies <br />APPENDIX A <br /> <br />PREWORK ASBESTOS INSPECTION CHECKLIST <br /> <br /> <br /> Name of State Facility: _____________________________________________________ <br /> <br /> Project Name: ___________________________________________________________ <br /> <br /> Project ID Number: _______________________________________________________ <br /> <br /> Date of Inspection: _________________ Pass: ________ Fail: _________ <br /> <br /> <br />A. DOCUMENTS YES NO <br /> <br />1) Asbestos Removal Permit/NESHAP Notification _____ _____ <br />2) Accreditation Documents for Workers & Supervisors _____ _____ <br />3) Asbestos Plans and Specifications _____ _____ <br />4) Air Monitoring Data _____ _____ <br />5) Waste Shipment Records _____ _____ <br />6) Sign-in Sheets and Bound Book for Comments _____ _____ <br />7) Calibration Record for Grade “D” Air _____ _____ <br />8) Items listed in Section 01043 of Specification _____ _____ <br /> <br />B. PPE SUPPLIES <br /> <br />1) Tyvek Clothing _____ _____ <br />2) Rubber Boots _____ _____ <br />3) Respirators with HEPA Filters _____ _____ <br /> <br />C. CLEAN ROOM <br /> <br />1) Entry Curtains _____ _____ <br />2) Emergency Phone Numbers Posted _____ _____ <br />3) First Aid Kit _____ _____ <br />4) Asbestos Signs _____ _____ <br />5) Decontamination Procedures Posted _____ _____ <br />6) Fire Extinguisher _____ _____ <br /> <br />D. SHOWER ROOM <br /> <br />1) Polyethylene Curtains _____ _____ <br />2) Hot/Cold Water & Operational _____ _____ <br />3) Soap & Towels _____ _____ <br />4) Wastewater Filter Pump Operational _____ _____ <br />5) Extra Five Micron Size Filters _____ _____ <br />DocuSign Envelope ID: 09980A3B-0691-41B4-854D-3865F2287392