Safety, Health and Injury Management 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.

Personal details


Required

Required

Required

Required

Working at UWA


Are you staff or contractor?
Working / Studying at UWA
Are you currently working / studying at UWA (at time of reporting)?
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Building Details


Enter the address of the building e.g. 22 Hobbs Avenue and the room number.

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? By engaged asbestos assessor? 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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When was exposure reported into UWA Electronic Incident Reporting System / UWA Safety / UWA IMW

Camms https://uniwa.sharepoint.com/sites/sd-Safety/SitePages/Report-a-safety-hazard,-incident-or-near-miss.aspx

Exposure activities - were you


What were you doing, occupation, the ACM its condition etc..
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.
Advised
Were you told that you were working with or near asbestos?
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If so, who advised you that you that you were working with or near asbestos?

Provide details of any warning labels or stickers in the area.

Where located at the time of exposure.

This only relates to exposure at UWA.

Health Surveillance / Medical Advice


Have you undergone testing e.g. a low dose CT Scan, X-ray, lung function test etc? If yes please go to next question.

Please provide more information on the tests you have undergone.