Health and Safety

Executive

Control of Asbestos Regulations 2012 (CAR) regulation 9

Notification of asbestos work

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*Is this a new notification or are you updating previously submitted details?

New

Update

Notification Number

Email

*Licence Number

*Licence expiry date

Withdrawal

About you, the licence holder

Note: for addresses you must provide Address Line 1 or 2, Town and postcode at minimum

*Licence Holder Name

Address Line 1

(eg building name)

Address Line 2

(eg street)

Address Line 3

(eg district)

*Town

County

*Post Code

*Phone Number

*E-Mail

Remember me

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To improve the management of licensed asbestos work through auditing by the asbestos industry, HSE may share

limited data provided on the ASB5 form with trade associations and relevant bodies. The data shared will be limited to: name of licensee, licence expiry date, site location, dates of work, nature of work.

Health and Safety

Executive

Notification of asbestos work

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Job details

Who are you contracted to?

*Name

*Phone Number

Contact

*Title

*Forename

*Family Name

Main site address where asbestos work is to be carried out

Note: for addresses you must provide Address Line 1 or 2, Town and postcode at minimum

Address Line 1

(eg building name)

Address Line 2

(eg street)

Address Line 3

(eg district)

*Town

County

*Post Code

*Multiple site addresses?

Yes

No

Details of other addresses

Local authority area

*Country

*Geographical Area

*Local Authority

*Exact work location or description of where on these premises work is to be carried out

Person preparing plan of work

Name

*Title

*Forename

*Family Name

*Mobile Number

Site supervisor

Name

*Title

*Forename

*Family Name

*Mobile Number

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Health and Safety

Executive

Notification of asbestos work

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Job details (continued)

Timing and duration of work

*Actual start date of

set up on site

*Does this notification

require a waiver?

Yes

No

*Duration

(no of days)

*Expected finish

date of work

Start and finish times

*Will there be night working?

Yes

No

*Will there be weekend working?

Yes

No

*Will there be a significant cessation / pause during the asbestos work?

Yes

No

Details if there will be a significant cessation / pause

About the work

*ACM Type (choose all that apply)

Asbestos coating

Asbestos insulation

Asbestos insulating board

Other

*Work to be undertaken (you must choose at least one)

Removal

Repair

Environmental

Decontamination

Encapsulation

Other

*General condition of asbestos material

Good

Poor

*The main type of asbestos (you must choose at least one)

Chrysotile

Amosite

Crocidolite

Other

*Please provide brief details of the type of work to be undertaken, general condition and main type of asbestos

*Size of job (area or volume)

*Number of persons employed per shift:

Minimum

Maximum

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Health and Safety

Executive

Notification of asbestos work

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Control measures and risks

*What combination of control measures will be used to reduce exposure as low as is reasonably practicable?

BS8520 controlled Wet strip equipment

Enclosure of work under negative pressure

Shadow vacuuming

Intact removal of whole AIB panels / tiles etc

Wrap and cut technique

RPE

Decontamination procedures using an asbestos

decontamination unit

Other

*How will the work be supervised and monitored? (you must choose at least one)

Viewing panels

CCTV

Enclosure entry

Other

*Are there any non-asbestos risks that make the

asbestos work more difficult?

Yes

No

(e.g. work on or in proximity to hot surfaces, work near live electrical installations, restricted working space, overhead removal, working at height)

If yes, what are these risks?

*Is the asbestos removal taking place on special premises? (Nuclear licensed site, Offshore platform, Railway premises)

Yes

No

Special premises

Other licensed asbestos holders

*Are other licensed asbestos holders involved in this work? ( eg: scaffolders, supervisory licence holders)

Yes

No

If Yes, insert the name of each asbestos licence holder and click Add to include them in the list.

Name

List of other licence holders

*Who is the enforcing authority?

Health & Safety Executive

Local Authority

Authorisation

*I declare that an ACoP compliant plan of work has been prepared

Notified by

*Title

*Forename

*Family Name

*Notified by position

Please check your email address below. Ensure that you change if incorrect as this is the email address that your acknowledgement and a copy of the form will be sent to.

*Email

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