DGM
RLB
GM
Inspection Date
Inspection Time
Inspector
Project Name
Specific Site
Company
Superviser
Type of Inspection
Work being Conducted
Pre-Construction
Pre-Commencement
Work Inspections
Pre-Encapsulation Inspection
Visual Clearance
Post-Clearance
Mobilization
Pre Cleaning
Containment Setup
Containment Repair
Demo Non Hazardous
Demo Hazardous
Abatement
Detail Cleaning
Final Cleaning
Encapsulation
Other
PERSONAL PROTECTION
Half Face NP
Full Face NP
Half Face PAPR
Full Face PAPR
None
Other
HEPA
Organic Vapor
HEPA/Organic Vapor
Acid Gas
Other
Cartridge
Respiratory Protection
Yes
No
Yes
No
Foot Covering being used
Protective Clothing being worn
Safety Shoes being worn
Head Covering being used
WORK SITE CONDITIONS
Warning Signs Acceptable
Containment Acceptable
Decontamination Unit In place
Security Fencing Acceptable
Worker Decon Procedures being used
Waste-out Unit In place
Equip. Decon Procedures being used
Material Decon Procedures being used
Proper Hygiene Materials (soap/towels)
Filtration for waste water inplace
Negative Pressure being Maintained
Sanitary conditions being maintained
WORK PRACTICES AND EQUIPMENT
ACM Adequately wetted
HEPA Vacuum being used
Dry Removal being performed
Surfactant being used
Waste Adequately wetted
ACM Promptly being bagged/contained
Prompt removal of Waste from area
Personal Air Sampling being conducted
Observations
Problems
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