Sample Record Keeping Forms Page 3

ADVERTISEMENT

Form 3. A sample maintenance work authorization form
Maintenance Work Authorization Form
Maintenance Work Authorization Form
No.
No.
Authorization
Authorization
Authorization is given to proceed with the following maintenance work:
Authorization is given to proceed with the following maintenance work:
Presence of Asbestos- Containing Materials (ACM)
Presence of Asbestos-
Asbestos - containing materials (ACM) are not present in the vicinity of th e maintenance work.
Asbestos - containing materials (ACM) are not present in the vicinity of th e maintenance work.
ACM is present, but its disturbance is not anticipat ed; however, if conditions change, the Asbestos Program
ACM is present, but its disturbance is not anticipat ed; however, if conditions change, the Asbestos Program
Manager will re - evaluate the work request prior to proceeding.
Manager will re - evaluate the work request prior to proceeding.
ACM is present, and may be disturbed.
ACM is present, and may be disturbed.
Work Practices if Asbestos- Containing Materials are Present
Work Practices if Asbestos-
The following work practices shall be employed to avoid or minimize disturbing asbestos:
Personal Protection if Asbestos -
Personal Protection if Asbestos -Containing Materials are Present
The following equipment/clothes shall be used/worn during the work to protect workers:
(manuals on personal protection can be referenced)
(manuals on personal protection can be referenced)
Special Practices and/or Equipment Required:
Special Practices and/or Equipment Required:
Signed:
Signed:
Date:
Date:
(Asbestos Program Manager)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 4