ASBESTOS / LEAD
PROJECT ASSESSMENT FORM
Date: This project is for ...Drop Box...
PROJECT MANAGER: ...Drop Box... OR TYPE IN NAME & PHONE NUMBER
BUILDING TO BE ABATED:
AREA OF ABATEMENT:
Assessment Approval Date:
Fund Number: Anticipated start date:
Any project may disturb construction materials (Select all that apply):
...Drop Box... ...Drop Box... ...Drop Box... ...Drop Box...
Provide a general description of work to be performed and building systems that may be disturbed (HVAC,
plumbing, etc.). Attach building floor plans and high-light areas of proposed work. Also include a description of
the extent of demolition being performed.
Forward this form to the Safety Manager as soon as possible before project starts. Remember that it could take a
week to schedule the inspection and 10 days before asbestos materials can be removed. All form information needs
to be completed along with floor plans before an assessment can be done.