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Policy Name: Mandatory Asbestos Reporting
Policy No: MAR1-0716
Effective Date: 7-1-2016
Review Date: 7-1-2016
Version No: 1
This form shall be completed and returned to BCV SYSTEMS for all sites where our employees may be
performing activities.
29 CFR 1926.1101, Toxic and Hazardous Substances
OHSA requires that building and/or facility owners notify all employers of employees who will be
performing work within or adjacent to areas containing ACM (Asbestos Containing Material) or PACM
{Presumed Asbestos Containing Material) of the presence, location and quantity of ACM or PACM, at
the work sites in their buildings and facilities.
Site Information:
Site Name:
Address:
City, State, Zip:
Asbestos Information:
Site contains ACM (Asbestos Containing Material) or PACM (Presumed Asbestos Containing Material)
in or adjacent to work sites in buildings or facilities where BCV SYSTEMS employees may be
performing work.
Yes No
If yes, then detailed information shall be attached in regard to:
The location and quantify ofmaterials.
How the site achieves compliance with permissible exposure limits?
Any equipment, precautions, etc. needed for BCV SYSTEMS employees that may be performing
functions in the work areas.
The information provided shall be reviewed and approved by BCV SYSTEMS prior to any work being
done by a BCV SYSTEMS employee. Note: Additional information may be required as part of the review
process.
Person Completing Form:
Name:
Title:
Contact Information:
1815A E. Seminole St Springfield, MO 65804 417-351-2964 www.bcvsystems.com
