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The 65 Asbestos form is an important document that licensed asbestos removalists must complete prior to starting any asbestos removal work. This form needs to be submitted at least five calendar days before the work begins, ensuring that necessary parties are informed and prepared. Key information includes the licensed removalist's name, license number, and contact details. The supervisor in charge of the asbestos removal work must also be identified, along with their contact information. Additionally, those responsible for conducting inspections and issuing clearance certificates must be specified, enhancing accountability. The form requires details about the client or business for which the removal is being performed, including the location of the work and the expected start and finish dates. It also prompts removalists to categorize the type of asbestos and estimate the quantity to be removed. By filling out sections on work methods and notifications to neighbors, the form emphasizes safety and compliance with regulations. Finally, the person completing the form must provide their details and submit the form to the relevant authorities, ensuring that all actions are recorded and overseen appropriately.

65 Asbestos Example

FORM 65

V25.1.12

Notification of licensed asbestos removal work

ABN 13 846 673 994

Work Health and Safety Act 2011

(to be completed by licensed asbestos removalist at least five calendar days before licensed asbestos removal work commences)

1. Licensed removalist

Name that appears on the asbestos removalist licence

Licence number

 

 

Licence expiry date

/

/

 

 

 

 

 

 

Licence class

 

A class licence

 

B class licence

 

 

 

 

 

 

 

 

State / territory / Commonwealth that issued the licence

 

 

 

 

 

 

 

 

 

 

Registered business name of the licence holder

 

 

 

 

 

 

 

 

 

ABN:

 

 

 

 

 

 

 

 

Business contact details

 

Working hours: (

)

Mobile:

 

 

 

 

 

 

 

 

 

2. Supervisor for asbestos removal work

Name of supervisor for the asbestos removal work

Mr / Mrs / Miss / Ms

First name

 

 

Surname

 

 

 

 

 

Supervisor’s contact details

Working hours: (

)

 

Mobile:

 

 

 

 

 

3. Person to conduct inspection and issue clearance certificate

Person conducting clearance inspection and

Asbestos assessor (must be licensed

Competent person

certificate is a:

after 31/12/2013)

 

 

 

 

 

 

Name of the person/s who will be inspecting and issuing the clearance certificate (if known)

 

Mr / Mrs / Miss / Ms

 

 

 

First name

 

Surname

 

 

 

 

 

Contact phone number

Phone: (

)

Mobile:

 

 

 

 

4. Client or person for whom the work is being performed

Client name

 

 

 

 

 

 

 

 

 

 

Mr / Mrs / Miss / Ms

 

 

 

 

 

 

 

 

 

 

 

First name

 

 

 

 

Surname

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact phone number

Phone: (

)

 

 

Mobile:

 

 

 

 

 

 

 

 

 

 

 

Trading name of business / person in control of the workplace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address where the asbestos removal will take place

 

 

 

 

 

 

 

No

Street name

 

 

 

 

 

 

Street type

 

Suburb

 

 

 

 

 

State

 

Postcode

 

 

 

 

 

 

 

 

 

 

 

Specific location within the site (If the site is a large workplace)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of place/plant (eg. domestic premises, shopping centre, child care centre, plant)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date the asbestos removal work is expected to commence:

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date the asbestos removal work is expected to finish:

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of asbestos to be removed

 

 

Friable

 

 

 

 

 

Non-friable (bonded)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Estimated quantity of asbestos to be removed (m2, kg, bags)

 

 

 

 

 

JAG 11/4257

 

 

 

 

 

 

 

 

 

 

 

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5. Details of work methods

Number of workers to be used for the asbestos removal work:

Name and competency details of the workers used for the asbestos removal work

(refer fact sheet Asbestos transitional arrangements for competency information):

First Name

Surname

Competency Details

If friable asbestos is to be removed, describe the method to be used (e.g. the way the area of removal will be enclosed, specific wet method)

Describe actions taken/to be taken to advise neighbours of intended asbestos removal work

6. Person completing this form

Your name

 

 

 

 

 

 

Mr / Mrs / Miss / Ms

 

 

 

 

 

 

First name

 

 

Surname

 

 

 

 

 

 

 

 

 

Position within business or undertaking

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact phone number:

Phone: (

)

 

Mobile:

 

 

 

 

 

 

 

 

 

Signature (not required where lodged via email)

 

 

Date:

/

/

 

 

 

 

 

 

 

Lodging your notification

Submit your completed notification to Advisory and Assessment Centre, Office of Fair and Safe Work Queensland by email, fax or post.

Email : whsnotification@justice.qld.gov.au or

Facsimile: (07) 3872 0501

Post: Office of Fair and Safe Work Queensland

PO Box 820

LUTWYCHE QLD 4030.

PRIVACY STATEMENT: The Department of Justice and Attorney-General collects, uses, discloses and stores information in accordance with legislation it administers and all applicable privacy laws. This includes information collected by inspectors of the Department. Note that privacy laws do not apply if other laws conflict or allow or require the collection of information, and do not apply to the collection of information by Department of Justice and Attorney-General to the extent that it is exercising its law enforcement functions and non-compliance with privacy legislation is deemed necessary to fulfil those functions. The Department of Justice and Attorney-General privacy information is on our website at www.justice.qld.gov.au.

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JAG 11/4257

Form Characteristics

Fact Name Details
Form Purpose This form notifies authorities about licensed asbestos removal work.
Submission Deadline Must be completed at least five calendar days before the work starts.
Governing Law Work Health and Safety Act 2011 applies.
Required Information The form requires details about the licensed removalist and the asbestos supervisor.
Privacy Statement Information is collected and stored as per applicable privacy laws.

Guidelines on Utilizing 65 Asbestos

The 65 Asbestos form is an important notification that licensed asbestos removalists must complete before starting any removal work. Filling it out accurately ensures compliance with regulations and helps maintain safety standards. Here’s how to fill it out step by step.

  1. Begin with the section for the Licensed removalist. Fill in your name as it appears on your asbestos removalist licence, the licence number, expiry date, and the class of licence (A or B). Specify the state or territory that issued the licence and enter the registered business name along with your ABN and contact details, including your working hours and mobile number.
  2. Next, provide details for the Supervisor for asbestos removal work. Input the supervisor’s name, contact information, and working hours.
  3. In the third section, list the Person to conduct inspection and issue clearance certificate. Include their name, whether they are a licensed asbestos assessor, contact phone number, and mobile number if known.
  4. For the Client or person for whom the work is being performed, enter the client’s name and contact phone number. Also, provide the trading name of the business or person in control of the workplace, the address where the work will occur, and specifics about the type of place (like a shopping center or domestic premises).
  5. Fill in the expected commencement and completion dates for asbestos removal, the type of asbestos to be removed (friable or non-friable), and the estimated quantity to be removed.
  6. Move on to the Details of work methods. State how many workers will be used for the removal, list their names alongside their competency details, and describe the method to be used if friable asbestos is involved. Also, note any actions taken to notify neighbors about the planned removal work.
  7. Finally, complete the section for the Person completing this form. Provide your name, position within the business, contact phone number, and signature (if not lodged electronically). Don’t forget to include the date of completion.

Once everything is filled out, submit the completed form to the Advisory and Assessment Centre via email, fax, or post. Ensure that your submission is made at least five calendar days before the planned removal work begins to meet regulatory requirements.

What You Should Know About This Form

What is the purpose of the 65 Asbestos form?

The 65 Asbestos form is a notification document used by licensed asbestos removalists in Australia. It must be completed and submitted at least five calendar days before any licensed asbestos removal work begins. The purpose of the form is to provide relevant authorities with essential information about the planned asbestos removal, such as details about the removalist, the supervisor, the location of the work, the types of asbestos being removed, and the methodologies to be employed during the removal process. This notification helps ensure compliance with safety regulations and promotes the safe handling of hazardous materials.

Who is required to complete the 65 Asbestos form?

The form must be completed by a licensed asbestos removalist. This individual or company holds a valid asbestos removal license to operate in Australia. Alongside providing their name, license number, and contact information, the removalist is responsible for filling out details regarding the asbestos removal work, including the names of supervisors and inspectors involved in the project. Any person authorized to manage the business or workplace where the removal will occur may also be involved in the completion of some sections of the form.

How should the 65 Asbestos form be submitted?

After completing the form, the licensed removalist must submit it to the Advisory and Assessment Centre of the Office of Fair and Safe Work Queensland. The submission can be done via email, fax, or post. The email address for submission is whsnotification@justice.qld.gov.au, and the fax number is (07) 3872 0501. If submitting by post, the form should be sent to the Office of Fair and Safe Work Queensland, PO Box 820, Lutwyche QLD 4030. Accurate submission ensures that the necessary authorities are informed and can take action if required.

What information is typically included in the 65 Asbestos form?

The 65 Asbestos form requires several types of information. Essential details include the name and license number of the asbestos removalist, the license expiry date, and the contact information for the supervisor overseeing the work. Additionally, the form seeks information about the client for whom the work is being performed, including their details and the location of the removal. Specific sections require information on the type and amount of asbestos being removed, the methods planned for the removal, and the number of workers involved. Properly filled out, this information aids in ensuring that all parties are aware of the operations and their related safety protocols.

Common mistakes

Completing the 65 Asbestos form incorrectly can lead to serious consequences for those involved in asbestos removal work. One common mistake is failing to provide accurate details about the licensed removalist. Users should double-check that the name, license number, and expiration date are correct. Inaccuracies can delay the process and may even lead to penalties.

Another significant error occurs when the supervisor for the asbestos removal work is not properly identified. It is critical to list the correct name and contact information. This person plays a key role in ensuring the removal processes are followed safely and legally. Neglecting this detail could lead to misunderstandings and miscommunication among the team.

Many applicants also overlook the section about the person conducting the inspection and issuing the clearance certificate. This individual must hold a competent person certificate, which must have been issued after December 31, 2013. Failing to provide this information will hinder the clearance process and could leave potential hazards unaddressed.

Misrepresenting the client's details is a mistake that should be avoided. The form requires clear identification of the client, their contact information, and the specific location of the work. An incomplete or ambiguous address can complicate notifications to neighbors and other relevant parties, putting everyone at risk.

Lastly, underestimating the quantity of asbestos to be removed or the number of workers involved can lead to logistical challenges. Ensure to provide precise estimates and a clear description of the work methods. This oversight can significantly affect planning and safety protocols.

Documents used along the form

The 65 Asbestos Form is a crucial document for notifying relevant authorities about licensed asbestos removal work. However, several other forms and documents are typically involved in the asbestos removal process to ensure compliance with safety standards and regulations. Below is a list of additional forms and documents often used in conjunction with the 65 Asbestos Form.

  • Asbestos Management Plan: This document outlines how asbestos-containing materials will be managed within a facility. It includes details about the location and condition of asbestos, as well as procedures for maintenance and removal.
  • Clearance Certificate: Issued after inspection by a licensed asbestos assessor, this certificate confirms that the area is safe for reoccupation following asbestos removal.
  • Asbestos Removal License: This license is held by the asbestos removalists and ensures that they are qualified to carry out asbestos removal. It lists details such as the license number and classes for which the license is valid.
  • Notification of Asbestos Work: This form notifies local authorities of planned asbestos work and provides pertinent details about the scope of the project and the workers involved.
  • Work Method Statement: This document describes specific procedures and safety measures that will be implemented during the removal process, including how workers will be protected from asbestos exposure.
  • Risk Assessment: A detailed analysis that identifies potential hazards related to asbestos work and evaluates the risks involved, guiding the implementation of control measures.
  • Site Inspection Report: Compiled by a licensed assessor, this report documents the condition of the work area before and after the removal process, assessing any potential risks associated with asbestos exposure.
  • Employee Training Records: These documents demonstrate that the workers involved in the asbestos removal have received proper training. They often include certifications and proof of ongoing education related to asbestos handling and safety.

Each of these documents plays a critical role in ensuring the safe handling, removal, and disposal of asbestos. By following established protocols and maintaining comprehensive records, the safety of both workers and the public can be better protected during asbestos-related activities.

Similar forms

  • OSHA 300 Log of Work-Related Injuries and Illnesses: Similar to the 65 Asbestos form, the OSHA log requires documentation of workplace incidents and potential hazards, emphasizing safety in occupational environments.
  • Environmental Protection Agency (EPA) Notification of Asbestos Abatement: Like the 65 Asbestos form, this document is necessary before asbestos removal and serves to inform relevant authorities about the planned activities.
  • Hazard Communication Standard (HCS): This document outlines the necessary communication of hazardous materials in the workplace, similar to how the 65 form addresses the specific hazards of asbestos.
  • State-Specific Asbestos License Application: This application is like the 65 form in that it requires detailed information about the licensed asbestos handler, ensuring compliance with safety regulations.
  • Site-Specific Health and Safety Plan: This plan details safety measures for specific work sites, paralleling the 65 Asbestos form’s focus on safety for asbestos removal work.
  • Worker Training Records for Asbestos Safety: Just as the 65 form documents workers' competency, these records track training completion, ensuring workers are prepared to handle asbestos safely.
  • Independent Air Monitoring Reports: Similar to the 65 form, these reports provide necessary documentation concerning air quality and potential asbestos exposure during removal activities.

Dos and Don'ts

When filling out the 65 Asbestos form, attention to detail is essential. Here are some important dos and don’ts to keep in mind:

  • Do ensure all information is accurate and complete before submission.
  • Do confirm that the licensed removalist's name matches the license exactly.
  • Do provide valid and current contact information for all involved parties.
  • Do double-check the dates for the start and finish of the asbestos removal work.
  • Don't leave any field blank unless it specifically states that it is not required.
  • Don't use outdated contact details; always verify prior to submitting the form.
  • Don't forget to include the specific type and estimated quantity of asbestos.
  • Don't submit the form less than five calendar days before the work commences.

Completing the 65 Asbestos form accurately will help ensure a smoother process for your asbestos removal project. Timely and correct submissions can prevent work stoppages or legal complications.

Misconceptions

  • Form 65 is only for large businesses. This is not true. Any licensed asbestos removalist, regardless of business size, must complete this form before commencing work.
  • You can submit the 65 Asbestos form on the day of the project. Unfortunately, this is incorrect. The form must be submitted at least five calendar days before any asbestos removal work starts.
  • Only the project manager needs to fill out the form. This is misleading. Various individuals, including the licensed removalist and the supervisor, must provide information on the form.
  • All asbestos removal work is the same. In reality, different types of asbestos require specific removal techniques. The form captures these differences to ensure safe handling.
  • Once you send the form, you're done. This misconception overlooks the fact that ongoing communication may be necessary, especially if work conditions change.
  • The form guarantees safety during removal. While the form helps with compliance, it does not guarantee absolute safety. Proper safety measures and skilled personnel are crucial for effective asbestos removal.
  • This form is not important for compliance. On the contrary, submitting the form is a legal requirement under the Work Health and Safety Act 2011 and is critical for compliance.
  • You can use any method to notify authorities. This is incorrect. Notifications must be sent specifically to the Advisory and Assessment Centre via the outlined methods in the form.
  • The completed form is confidential and not shared. While the form includes privacy statements, the information may be shared where legal obligations exist. Always be aware that compliance might require disclosures.

Key takeaways

Filling out and using the 65 Asbestos Form is a meticulous process that requires attention to detail. Below are key takeaways that can help you navigate this important task.

  • Timing is Crucial: The form must be completed and submitted at least five calendar days before any licensed asbestos removal work begins. This timeframe ensures compliance with safety regulations.
  • Identify the Licensed Removalist: Clearly state the name, license number, and relevant details of the licensed asbestos removalist. This information is fundamental for regulatory approval.
  • Supervisor Information: Include the name and contact details of the supervisor responsible for the asbestos removal work. This person plays a key role in overseeing safety.
  • Inspection and Clearance: Identify the person who will conduct the clearance inspection and issue the corresponding certificate. This individual must hold a valid license as an assessor.
  • Client Details: Fill out the client’s name and contact information accurately. In addition, provide a clear address for where the asbestos removal will occur.
  • Specify the Asbestos Type: Indicate whether the asbestos to be removed is friable or non-friable, and provide an estimate of the quantity. This information is critical for risk assessment.
  • Work Methods: Detail the number of workers involved in the removal process and their competency information. If friable asbestos is present, describe the methods to be employed, including protective measures.
  • Ensure Clear Communication: Actions taken to inform nearby residents about the planned asbestos removal must be documented. This is vital for community safety and awareness.
  • Submission Methods: The completed form can be submitted via email, fax, or postal service to the relevant authority. Ensure to follow the guidelines provided for each submission method.

Paying attention to these key points can simplify the process of filling out and submitting the 65 Asbestos Form, ensuring that the asbestos removal complies with safety laws.