Environmental Health And Safety Verification Form printable pdf download

Environmental Health and Safety Verification Form

______________________________________________________

(School Name)

________________________ (the “School”) maintains buildings (the “Buildings”) located at

____________________ (Address ). The Buildings have been inspected for the presence of asbestos-

containing materials as part of the School’s asbestos Management Plan. This Management Plan was

developed in accordance with the Asbestos Hazard Emergency Response Act of 1986 (P.L. 99-519) and

the federal rules and regulations enacted thereunder from time to time (collectively, “AHERA”). The

School’s most recent AHERA 3-Year Re-inspection Report is located in the School office and is available

for review.

The undersigned contractor (the “Contractor”) desires to perform work for the School in or

around the Buildings. The School requires contractors who perform work for the School in or around

the Buildings to comply with all applicable environmental, safety and health regulations, including, but

not limited to AHERA, as a condition to being permitted to perform work at the School. Accordingly, the

Contractor is required to provide evidence to the School of the Contractor’s compliance with all

applicable environmental, safety and health regulations and to provide such evidence to School

personnel. At a minimum, the following documentation must be maintained by the Contractor and

should be delivered to the School‘s principal or business manager prior to the Contractor’s beginning

work for the first time and then annually thereafter.

Applicable Asbestos Training Certifications for all Contractor personnel performing work in or

around the Buildings in accordance with 29 CFR 1926.1101 and the Ohio Revised Administrative Code.

Evidence of compliance with all training requirements of the Occupational Safety and Health

Administration which govern work activities and procedures relevant for work performed by each

Contractor.

No Contractor personnel performing work in or around the Buildings should make contact with

any existing asbestos-containing material. Only licensed, trained and accredited asbestos abatement

contractors shall be permitted to contact asbestos-containing material and to repair, encapsulate,

enclose, or remove asbestos-containing materials in or around the Buildings.

In the event that Contractor personnel encounter asbestos-containing materials not previously

known to the School, or Contractor personnel intend to conduct work that will contact existing asbestos-

containing materials (in each case “Asbestos Affecting Activity”), the Contractor shall immediately notify

the School’s principal or business manager before undertaking any Asbestos Affecting Activity. The

School shall engage an appropriate asbestos abatement contractor to mitigate any asbestos exposure

before the Contractor shall be permitted to continue work in or around the Buildings.

Additional questions or comments related to asbestos or other environmental, safety and health

hazards shall be forwarded to the undersigned School official at the phone number listed below.

Environmental Health And Safety Verification Form