Asbestos Clearance Certificate Example
Example document for Asbestos Clearance Certificate. Use this as a reference when creating your own.
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Document: Asbestos Clearance Certificate
Example Document
Last updated 7/29/2026
ASBESTOS CLEARANCE CERTIFICATE
1. PROJECT DETAILS
Site Address: 42 Smith Street, Richmond, VIC, 3121
Client Name: JKL Holdings Pty Ltd
Asbestos Removal Licence Number: 12345678-9
Date of Inspection: 15/10/2023
Time of Inspection: 14:00 to 15:30
2. INSPECTOR DETAILS
Name of Inspector: Sarah Jones
Qualifications: Certified Occupational Hygienist (COH) and Licensed Asbestos Assessor
Inspector Contact Number: 0412 345 678
Declaration of Independence: I declare that I was not involved in the asbestos removal work conducted at this site.
Signature: S. Jones
Date: 15/10/2023
3. SCOPE OF REMOVAL WORK
Area Cleared: Ground floor commercial bathroom and ceiling space above.
Type of Asbestos Removed: Non-friable
Description of Materials Removed: 10 square metres of asbestos vinyl floor tiles and mastic. 5 linear metres of asbestos cement eave sheets.
Date Removal Work Completed: 14/10/2023
4. CLEARANCE INSPECTION FINDINGS
I hereby certify that I have conducted a clearance inspection of the area listed above.
Visual Inspection
I confirm that a thorough visual inspection of the work area and surrounding areas has been completed. Inspection included the floor substructure, walls, ceiling cavity, and adjoining corridor.
Result: [X] PASS / [ ] FAIL
Comments: No visible asbestos debris or dust found. All surfaces are clean. Polyethylene containment has been removed. Warning signs have been removed.
Air Monitoring (If applicable)
Air Monitoring Conducted: [X] YES / [ ] NO
Laboratory Reference Number: LAB-998877
Result: [X] PASS / [ ] FAIL
Fibre Count: <0.01 fibres/mL
Comments: Static and background air monitoring levels below the detectable limit.
5. WASTE TRANSPORTATION
Waste Transport Certificate Number: WT-556677
Landfill Facility: Melbourne Regional Landfill
6. FINAL DECLARATION
I declare that the area detailed in Section 3 is free from visible asbestos residue and dust.
I confirm that all asbestos containing materials have been removed.
I confirm that the area is safe to reoccupy.
This certificate is issued without admission of liability and subject to the specified area not being disturbed by other trades prior to reoccupation.
Inspector Signature: S. Jones
Date: 15/10/2023
Client Acknowledgement:
I acknowledge receipt of this clearance certificate.
Client Signature: J. Smith (Manager)
Date: 16/10/2023
Notes
This example shows a clearance for a commercial bathroom involving both floor tiles and eaves. Note that the inspector is independent and a licensed assessor. Air monitoring was conducted despite it being non-friable material, which is best practice for commercial sites. The waste transport number is recorded to verify legal disposal.
About this Example
Part of the Asbestos Clearance Certificate document collection
Document Type
Asbestos Clearance Certificate
An official document confirming that an asbestos removal area has been inspected and is safe to reoccupy after removal work.