ASBESTOS CLEARANCE CERTIFICATE

1. PROJECT DETAILS

Site Address: [INSERT FULL STREET ADDRESS, SUBURB, STATE, POSTCODE]

Client Name: [INSERT COMPANY OR PROPERTY OWNER NAME]

Asbestos Removal Licence Number: [INSERT LICENCE NUMBER OF REMOVALIST]

Date of Inspection: [DD/MM/YYYY]

Time of Inspection: [INSERT TIME START] to [INSERT TIME FINISH]

2. INSPECTOR DETAILS

Name of Inspector: [INSERT FULL NAME]

Qualifications: [INSERT QUALIFICATION E.G. LICENSED ASBESTOS ASSESSOR / OCCUPATIONAL HYGIENIST]

Inspector Contact Number: [INSERT PHONE NUMBER]

Declaration of Independence: I declare that I was not involved in the asbestos removal work conducted at this site.

Signature: __________________________

Date: __________________________

3. SCOPE OF REMOVAL WORK

Area Cleared: [DESCRIBE SPECIFIC ROOMS, FLOOR OR AREA]

Type of Asbestos Removed: [FRIABLE / NON-FRIABLE]

Description of Materials Removed: [E.G. EAVES, FENCE, FLOOR TILES, LAGGING]

Date Removal Work Completed: [DD/MM/YYYY]

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.

Result: [ ] PASS / [ ] FAIL

Comments: [INSERT DETAILS OF CONDITION, NO VISIBLE DEBRIS OR DUST FOUND, SURFACES CLEAN]

Air Monitoring (If applicable)

Air Monitoring Conducted: [ ] YES / [ ] NO

Laboratory Reference Number: [INSERT LAB REF NUMBER]

Result: [ ] PASS / [ ] FAIL

Fibre Count: [INSERT COUNT] fibres/mL

Comments: [INSERT DETAILS IF REQUIRED]

5. WASTE TRANSPORTATION

Waste Transport Certificate Number: [INSERT NUMBER]

Landfill Facility: [INSERT NAME OF TIP]

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: __________________________

Date: __________________________

Client Acknowledgement:

I acknowledge receipt of this clearance certificate.

Client Signature: __________________________

Date: __________________________