ISU ASBESTOS TEAM JOB SUMMARY
BUILDING/ROOM:____________
AIR SAMPLING:
DATE COMPLETED:___________
PCM cassette #_____________________ Pump #________
Pump pre cal reading____________ Pump post cal reading___________
Total minutes of air sampling_______________
Flow rate:__________ Pump/cassette worn by:________________
DESCRIBE WORK COMPLETED:________________________________________________________________________________________________
JOB COMPLETED BY(signature):________________________
___________________________
Glove Bag Removal
Floor Tile Removal
Control Measures Utilized:
Control Measures Utilized:
___ area restricted to limit access by unauthorized personnel
___area restricted to limit access by unauthorized personnel
___ pipe insulation was removed by wet methods using
OSHA/EPA approved glove bag procedures
___Intact methods utilized(circle method) HEAT WET
___ exposed or loose ACM was encapsulated to lock down fibers
___ exposed or lose ACM was wrapped with lag cloth to lock
down fibers
___ personal air monitoring was conducted
___protective suit and respirator worn
___HEPA vac used for clean up if necessary
___material disposed of in approved waste bag and disposed
in ISU asbestos dumpster
___personal air monitoring was conducted
___other (please explain)
___ material disposed of in approved waste bag, HEPA
evacuated and goose necked
___waste bags disposed in ISU asbestos dumpster
___other (please explain)
Housekeeping/Encapsulation/O and M
Ceiling Tile Movement
Control Measures Utilized:
Control Measures Utilized:
___area restricted to limit access by unauthorized personnel
___area restricted to limit access by unauthorized personnel
___HEPA vac used for clean-up of loose/fallen material
___6 mil poly placed under work area
___wet methods used for clean-up
___HEPA vac used to clean the track and surrounding area
___exposed or loose ACM was encapsulated to lock down fibers
___ personal air monitoring was conducted
___exposed or lose ACM was wrapped with lag cloth to lock
down fibers
___protective suit and respirator worn
___power tool with HEPA vac attachment used when ACM was
disturbed
___material disposed of in approved waste bag, HEPA
evacuated and goose necked(if required)