Get WI DHS F-44016 2013-2024

Adm. Code ASBESTOS OCCUPANT PROTECTION PLAN This occupant protection plan is mandatory for asbestos abatement in an occupied or furnished facility and shall remain posted for the duration of the asbestos project. DEPARTMENT OF HEALTH SERVICES Division of Public Health F-44016 Rev* 1/13 Page 1 of 1 STATE OF WISCONSIN Bureau of Environmental and Occupational Health DHS 159 Wis. Only certified persons using appropriate personal protection may enter regulated work areas. Contractor - Describe the actions taken to ensure the health and safety of building occupants during this project in space below. If handwritten write clearly and legibly. Post this plan in plain view outside the regulated area for the project. Occupants Asbestos is a hazardous substance. The actions described below are meant to protect you and others nearby during this asbestos removal project. It is important to stay out of work areas while work is in progress and until permission is given to re-enter upon completion* The contractor will do daily clean-up but the regulated work area may still contain dangerous levels of asbestos until final cleaning is completed* ASBESTOS COMPANY INFORMATION Company Name Address DHS company No* City State Company Contact Person Zip Code Telephone No* ASBESTOS PROJECT INFORMATION Property Type or Proptery Name Property Contact Person Project work shifts am pm Project start date mm/dd/yy Project end date mm/dd/yy night PROJECT DESCRIPTION Type of project include type and amount of asbestos-containing material being removed or disturbed PROTECTIVE MEASURES Describe below actions taken to ensure occupant safety attach additional sheet if needed Containment or barrier system describe negative air system glovebag full containment mini-containment used for barrier Ventilation system shutdown describe areas where ventilation system has been shut down Work practices Describe use of wet methods debris-lowering system waste handling methods etc* Final cleaning and clearance Describe air scrubbing HEPA vacuuming wet cleaning use of encapsulant air sampling etc* WISCONSIN DEPARTMENT OF HEALTH SERVICES ASBESTOS PROGRAM Questions or Concerns Contact the Asbestos and Lead Section at 608-261-6876 Reset / Clear Form. Only certified persons using appropriate personal protection may enter regulated work areas. Contractor - Describe the actions taken to ensure the health and safety of building occupants during this project in space below. If handwritten write clearly and legibly. Post this plan in plain view outside the regulated area for the project. If handwritten write clearly and legibly. Post this plan in plain view outside the regulated area for the project. Occupants Asbestos is a hazardous substance. The actions described below are meant to protect you and others nearby during this asbestos removal project. Occupants Asbestos is a hazardous substance. The actions described below are meant to protect you and others nearby during this asbestos removal project. It is important to stay out of work areas while work is in progress and until permission is given to re-enter upon completion* The contractor will do daily clean-up but the regulated work area may still contain dangerous levels of asbestos until final cleaning is completed* ASBESTOS COMPANY INFORMATION Company Name Address DHS company No* City State Company Contact Person Zip Code Telephone No* ASBESTOS PROJECT INFORMATION Property Type or Proptery Name Property Contact Person Project work shifts am pm Project start date mm/dd/yy Project end date mm/dd/yy night PROJECT DESCRIPTION Type of project include type and amount of asbestos-containing material being removed or disturbed PROTECTIVE MEASURES Describe below actions taken to ensure occupant safety attach additional sheet if needed Containment or barrier system describe negative air system glovebag full containment mini-containment used for barrier Ventilation system shutdown describe areas where ventilation system has been shut down Work practices Describe use of wet methods debris-lowering system waste handling methods etc* Final cleaning and clearance Describe air scrubbing HEPA vacuuming wet cleaning use of encapsulant air sampling etc* WISCONSIN DEPARTMENT OF HEALTH SERVICES ASBESTOS PROGRAM Questions or Concerns Contact the Asbestos and Lead Section at 608-261-6876 Reset / Clear Form. .