Safety, Health and Wellbeing

Asbestos exposure form

Our role is to develop and assist in the implementation of the UWA safety, health and wellbeing programs in order to minimise the risk of injury, illness and property damage.

We provide consultancy and other services to promote best practice and legislative compliance in all University and related activities.

Employment


Please choose a year

Please select a year
Employment
Were you specifically employed to cut, saw and/or machine asbestos?
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Enter the address of the building e.g. 22 Hobbs Avenue.
Advised
Were you told that you were working with or near asbestos?
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If so, who advised you that you were working with or near asbestos?
Labelling
Were the asbestos-containing materials labelled as such?
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Diagnosis - has there been a diagnosis of

Asbestosis
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Lung cancer
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Mesothelioma
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Work history - During your employment by UWA have you worked in any of the occupations below?

Boilmaker
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Brickmason
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Operator
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Pipefitter
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Welder
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Steelworker
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Insulator
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Electrician
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Millwright
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Carpenter
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Maintenance Mechanic
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Sandblaster
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Machinist
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Grinder
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Labourer
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Operating Engineers
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Plumber
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Steamfitter
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Cement Plant Worker
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Construction Worker
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Chemical Plant Worker
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Furnace Worker
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Sheet Metal Worker
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Utility Worker
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Heating Technician
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Heating & Airconditioning Technician
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Please describe.

Exposure


List any materials you handle, or which are used near you as you work, which contain asbestos.

Include all the different work you do, in different parts of the workplace as necessary:

Were air samples taken? How often? By people you recognised? Were you told the results?

Other work with asbestos at or near your workplace (List any jobs done at your workplace which involve asbestos exposure even if you are not directly in contact with them).

List any materials you handle, or which are used near you as you work, which you think might contain asbestos.
Witness
Were there any witnesses to the exposure?
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If there were witness(es) please state full name and date of birth.
Environment
Was the exposure indoors or outdoors?
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Ventilation
Was the area ventilated eg where the windows and/or doors open?
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Exposure activities - were you

Plumbing
Insulating or lagging boilers?
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Electrical
Manufacturing or maintaining brakes or clutches?
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Insulation
Spraying insulation?
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Cutting
Repeatedly cutting asbestos board?
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Construction
Construction or demolition?
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Removing
Removing asbestos?
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Please describe eg washing an exposed persons' overalls.

Personal details


Required

Required

Required

Required