Loose Fill Asbestos Contamination Report Form (AF2015-18)
1.1	Property Details
Address:
	
Prepared for (Owner):
	Contact Details:
	
1.2	Licensed Asbestos Assessor Details
Assessor name: 
	Licence No.:
	
Company name: 
	Contact details:
	
Assessor Reference Number:
	Assessor Inspection Date:
	Assessor Report Date:
	
1.3	Licensed Asbestos Removalist Details
Removalist name: 
	Licence No.:
	
Company name: 
	Contact details:
	
Removalist Inspection Date:
	
1.4	Details for WorkSafe ACT
Copy For WorkSafe ACT (date sent):
	 Referred to WorkSafe ACT for investigation	
2	Information for owner/occupier

This report is a mandatory loose fill asbestos contamination report as required by regulations 341 to 344 of the Dangerous Substances Regulations 2004 (the Regulations) and approved under s 222 of the Dangerous Substances Act 2004 (Approved forms).
This property is a registered loose fill asbestos insulation affected property (i.e. a ‘Mr Fluffy’ home). It contains asbestos fibres in its walls, sub-floor area and roof space. Occupants of this property are at risk of ongoing exposure to loose fill asbestos fibres unless steps are taken to reduce fibre leakage from these building cavities into living areas.
It is important that owners understand that this report and the management actions required will not guarantee nil exposure to asbestos fibres. Owners have been advised by the ACT Government that these properties should be demolished and that they cannot be rendered safe without doing so.
It is important to understand that carpets, fabric items and soft furniture may be contaminated by asbestos fibres. There is no practicable method of confirming fabric items are or are not contaminated, nor is there any method whereby these goods can be rendered completely asbestos free.
You are thereby accepting a level of risk of ongoing exposure to asbestos fibres by choosing to live in this property.
This report records the results of a risk assessment of this property carried out by a licensed asbestos assessor to identify any loose fill asbestos contamination in living areas of the home. The assessor will also identify any damage to, or holes, in walls, ceilings, cornices, skirting boards or flooring that could allow loose fill asbestos fibres that are in the wall, sub floor or roof space building cavities to leak or migrate into the living areas.
The Regulations requires you -the owner- to engage a licensed asbestos removalist to carry out the mandatory management actions listed by the licensed asbestos assessor in the Contamination Management Plan table over leaf. This work must be completed as soon as possible but no later than 6 months after the date of the asbestos assessor inspection.
A description of the type of mandatory management actions that are required to be completed appears under the heading ‘Mandatory Management Actions required’. A Guideline for licensed asbestos assessors and licensed asbestos removalists on how to use this form is attached to this form.
If in the professional opinion of the licensed asbestos assessor or licensed asbestos removalist, you are at serious risk of exposure in your home from excessive amounts of asbestos fibre detected in your living areas or significant damage is apparent to the building, the case will be referred to WorkSafe ACT.
Should WorkSafe ACT be asked to investigate, the Asbestos Response Taskforce will work to support you in dealing with the situation.
If you have any questions about this form, you may discuss it with the licensed asbestos assessor listed on the front page or Work Safe ACT Asbestos Unit (ph 6207 3000
3	Contamination Management Plan
A visual inspection was made by a licensed asbestos assessor and dust samples were taken to determine whether loose fill asbestos fibres are present in living areas of this property. The following table records the results of the inspection and advises the required management actions that must be taken. It has been assumed that loose fill asbestos fibres are present in wall, roof or sub-floor building cavities. No inspection has been carried out of these areas. The owner of the property must commission a licensed asbestos removalist to complete the ‘Mandatory Management Actions Required’ within 6 months of the report date.
Assessor to Complete (Please Delete Lines Not Applicable)	Removalist to Complete	
Room location	Exposure pathway from building cavity (e.g. cornice crack, holes, vent, openings)	Sample no.	Asbestos Fibres Found (Yes/No)	Mandatory Management Actions Required (see key below)	Work Completed (asbestos removalist to sign)	Comments	
Kitchen							
– Storage							
Walk In Pantry							
Lounge Room							
– Storage							
Family Room							
– Storage							
Rumpus/Play Room							
– Storage							
Sunroom							
– Storage							
Laundry							
– Storage							
Main Bedroom							
– Storage							
Ensuite							
Toilet/Powder Room							
Walk In Wardrobe							
Bedroom 2							
– Storage							
Bedroom 3							
– Storage							
Bedroom 4							
– Storage							
Bedroom 5							
– Storage							
Main Bathroom							
Other Bathroom							
Other Toilet							
Utility Room							
– Storage							
Store Room							
– Storage							
Study							
– Storage							
Hallway							
Return Air							
Entry							
Garage/
Workshop							
– Storage							
Other:							
Other:							
Mandatory Management Actions Required – Key
This work may ONLY be done by a licensed asbestos removalist. One or more of these actions will be indicated by the licensed asbestos assessor, depending on the inspection and results of the dust sampling. If a licensed asbestos assessor considers that the contamination or damage to the property is severe and requires additional control measures not listed here, WorkSafe ACT will be informed.
A: Decontaminate
1.	Wet wipe and vacuum hard surfaces in this room only (approved Class H asbestos vacuum cleaner)
2.	Discard soft fabric items from contaminated cupboard (using labelled asbestos removal bag)
B: Label 
1.	Apply ‘Danger - Do Not Enter – Asbestos’  label to door , manhole or access to sub-floor, roof, or wall cavity
C: Lock
1.	Lock door or manhole to ceiling, wall or subfloor crawl space 
•	For external access areas / doors - barrel bolt/s with a padlock (keys left with owner)
•	For internal access points (e.g. manhole) –barrel bolt/s with a padlock (keys left with owner)
D: Seal
1.	Seal wall, ceiling, floor, cornices or architrave holes and cracks – using flexible paintable mastic (excluding silicone) or standard plaster compound/tape and spackle.
2.	Seal exposed wall, ceiling, floor cavity, or vents – cover with MDF, geo-fabric, media filter or plywood, and secured with adhesives or screws. If the penetration in wall or ceiling is small then use standard plaster compound/tape and spackle. NB   Do not seal or cover the openings of downlights or bathroom, toilet, laundry Tastics or ceiling exhaust fans.
3.	Seal cavity sliding door – seal open so inoperable with expanding foam
4.	Seal outer plate of heating or cooling duct to wall, floor or ceiling using paintable mastic, plaster compound/tape or spackle. N.B Do not seal or cover heating or cooling duct openings.
Appendix A: Analytical reports

Appendix B: Photos

Guide to Using This Form
This form is an approved form under s222 of the Dangerous Substances Act 2004 for use by licensed asbestos assessors and licensed asbestos removalists for complying with Dangerous Substances Regulations 341 to 344.
The purpose of this form is to assist assessors and removalists to carry out inspections to:
•	identify  loose fill asbestos contamination in the living areas of homes, 
•	identify exposure pathways such as holes, cracks, penetrations or gaps through which asbestos fibres might have migrated into living areas,
•	indicate a limited range of management actions to reduce the risk of ongoing exposure to asbestos fibres, and 
•	undertake preventative remediation work in accordance with the inspection carried out by the licensed asbestos assessor.
This report and the recommendations in it, if fully complied with, will reduce but not completely eliminate the risk of ongoing exposure to asbestos fibres from residual contamination from loose fill asbestos insulation in building cavities. Owners of these properties have been advised that it is not safe to live in these properties with ongoing exposure likely and they should be demolished. Any owner continuing to reside in this property does so at their own risk. 
This report falls short of recommending any maintenance or building work that might disturb the loose fill asbestos fibres in building cavities or require a building approval, and any remedial work that may make the property unsafe or unliveable. Should a licensed asbestos assessor identify extensive contamination or building damage, he/she should report the property to WorkSafe ACT.
This asbestos contamination report presumes that amosite or crocidolite loose fill asbestos fibres are contained within the roof, wall or sub-floor crawl space and that soft furnishings are likely to contain asbestos fibres. On that basis, no sampling is to be carried out in these areas or items. 
No air sampling is to be carried out.
Process
The licensed asbestos assessor engaged by the owner to prepare the report will inspect the property, making a visual assessment of the possible exposure pathways for asbestos to migrate into the living areas, and take settled dust samples to verify whether contamination has occurred through the identified exposure pathways. Once the assessor has completed the first half of the report and indicated mandatory management actions based on observed exposure pathways and settled dust sampling, the form must be signed and lodged with WorkSafe ACT and a copy provided to the owner. A licensed asbestos removalist engaged by the owner will obtain a copy of the partly completed form from Worksafe prior to starting a job. Once an asbestos removalist has completed the management actions and certified the work is completed, the form must be signed and lodged for a second time with WorkSafe ACT, and the completed copy provided to the owner. 

This is a diagram of the process:

Settled Dust Sampling
The purpose of settled dust sampling is to establish as far as reasonably practicable whether fibres have migrated through observed exposure pathways from the roof, walls or sub-floor cavities into living spaces. No sampling should be carried out in the presumed contaminated roof, wall or sub floor spaces, or from soft furnishings or fabric items. 
A licensed asbestos assessor should use their professional judgement and take 1-2 samples of dust from each room where there is an identified exposure pathway. Sampling of every room is not required where there are no identified exposure pathways. Space is provided on the form for most types of rooms/spaces. For most properties, approximately 10 samples could be expected as being reasonable. Assessors should take care neither to under or over-sample but take a reasonable number of samples to ascertain if a room is contaminated based on professional judgement.
Settled dust samples should only be taken from hard horizontal surfaces in internal living areas. Samples should not be taken from the interior of heating or cooling duct work, soft furnishings, clothes or carpets. The latter are presumed to be contaminated and are not practicable to decontaminate. 
No static air sampling is to be carried since airborne fibre levels are likely to be below the detection limit of the air sampling method. Laboratory analytical results should be appended to the report and recorded in the Contamination Management Plan table against the appropriate room/space.
Choosing Mandatory Management Actions
Based on the results of the dust sampling and visual inspection, the assessor should indicate one or more management actions, choosing from the codes listed in the Key to the table. 
In all properties, the manholes or access doors to sub-floor or roof area should be mandated for locking and labelling to limit casual entry to these spaces.
Where a property is in good condition with no exposure pathways and no contamination is identified, mandated management actions may be limited to locking and labelling building cavity access points (e.g. manholes).
Where an exposure pathway is identified and dust contamination is confirmed, an assessor should mandate that the room be decontaminated using wet wiping of hard surfaces and vacuuming the room with an approved asbestos type H vacuum cleaner. Only those exposure pathways in those rooms where asbestos dust is identified should be mandated for sealing. 
Where no fibres are detected in a room or space, it is not necessary to mandate sealing of exposure pathways, other than locking and labelling any manhole or cavity access.
If a property has significant damage such that wall, roof or sub-floor cavities open directly into living areas, whether or not fibres are detected in settled dust near the damage, the assessor should report the property to WorkSafe ACT. Where the assessor finds the majority or all of the dust samples are contaminated, the property should be reported to WorkSafe ACT.
Where an exposure pathway is identified and dust contamination is confirmed in a cupboard the owner should be advised that cleaning work will decontaminate hard surface items but that the asbestos removalist will dispose of soft items which cannot be decontaminated. If the owner refuses to allow their goods to be disposed of, this should be noted on the report.
Do not recommend covering or replacement of down lights, Tastics or ceiling exhaust fans. Whilst these are potential exposure pathways it should be noted that the roof space was remediated in an earlier program and that such work would require a building approval. 
Do not recommend heating or cooling systems be deactivated. 
Do not recommend soft furnishings be disposed of unless you have identified a contaminated cupboard space.
Do not attempt to sample nor mandate the disposal of carpets, fabric items and soft furniture as this is impractical. 
Do not mandate sealing open of cavity wall doors unless asbestos fibres are detected in one or other room on either side of the door.
Any photographs taken should also be appended to the report to make clear to asbestos removalists where work is to be carried out.
Lodging with WorkSafe ACT 
Once completed, the assessor should sign and date the report, provide a hard copy to the owner and lodge the form by email : worksafe_asbestos@act.gov.au 
The owner should be advised that they are required by law to engage a licensed asbestos removalist to carry out the management actions no later than 6 months from the assessor’s inspection date.
Remedial Work - Mandatory Management Actions
Worksafe ACT has advised that provided loose fill asbestos fibre contamination removed is only asbestos contaminated dust in living areas, that this work does not comprise friable asbestos removal according to the WHS regulations. However, safe working procedures for handling asbestos contaminated dust and respiratory protection are required as per the WHS Regulations. It is not mandatory that a nominated asbestos removal supervisor be present for this work, however normal management supervision is required. Asbestos removalist workers should be trained in the content of this guide, the need for careful sealing and effective use of materials and the techniques to be used. If workers have any queries in a premises or are in doubt about the work required, they may discuss it with their supervisor, the  licensed asbestos assessor who prepared the contamination report or the WorkSafe ACT Asbestos Unit (02) 6207 3000.
Cleaning up any asbestos contaminated dust on hard surfaces or items should be confined to the room or space where the assessor has identified asbestos fibres. This should be done using normal friable asbestos decontamination procedures including wet wiping and the use of well-maintained Class H asbestos approved vacuum cleaners. Carpets and curtains in rooms where asbestos contamination has been confirmed should be vacuumed where practicable although this cannot effectively remove embedded fibres. Other soft items such as clothes or linen are not practicable to decontaminate. 
Any soft items in confirmed contaminated cupboards should be disposed of in a correct asbestos removal bag. If the owner wishes to keep these contents against the assessor’s advice, please record this in the form.
Materials used to seal up, such as paintable mastics need to be applied in accordance with manufacturer’s instructions, applied to clean, dust-free surfaces and ensure the entire crack, hole or gap filled.
Do not enter any roof, wall or sub-floor cavity.
Do not cover the openings of ducted heating or cooling air inlets and outlets. These must be left operable. You should seal around the edges of the vent faceplate only.
Do not cover over down lights, Tastics, heating or cooling vent outlets or inlets or ceiling exhaust fans. Whilst these are potential exposure pathways it should be noted that the roof space was remediated in an earlier program and that such work would require a building approval.
Cavity sliding doors are an important exposure pathway due to residual fibres in wall cavities. Cavity doors are to be sealed open where contamination has been identified in one or other of the rooms on either side of the door. The gap must be entirely filled with expanding foam to render the door open and inoperable. 
Cornice cracks are an important exposure pathway due to residual fibres known to be present above the cornices that were unable to be removed in the previous remediation program. These should be completely and effectively sealed. Please ensure the paintable mastic is applied to dust-free surfaces. 
Sealants applied should be clear or colour free wherever possible.
Locking of manhole doors will be required in most properties. It is preferable that this be done with keys to the padlock provided to the owner. Completely sealing or covering of these should be avoided in case later maintenance under safe working conditions is required.