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The Rhode Island ASB 22 form is a crucial document for anyone planning to undertake asbestos-related work in the state. This form must be submitted to the Rhode Island Department of Health at least 10 working days before any on-site activities begin. It serves multiple purposes, including notifying the department about the type of work being performed—whether it’s an original notification, a revision, or a cancellation. The form collects essential information about the facility owner, asbestos contractor, and the specific details of the work to be done. It requires a thorough description of the facility, including its size, age, and current use, as well as the methods for detecting asbestos. Additionally, the ASB 22 form outlines the quantity of asbestos materials involved and provides a schedule for the removal process. It also addresses any emergency renovations that may arise unexpectedly, ensuring that proper procedures are in place for handling unforeseen asbestos discoveries. Certifications from the building owner or representative affirm that trained personnel will be present on-site, reinforcing compliance with federal regulations. By completing the ASB 22 form accurately, individuals can help ensure a safe and compliant asbestos abatement process.
Rhode Island Asb 22 Example
ASBESTOS START WORK NOTIFICATION
ThisThisformformmust be submitted 10 working days before
Asbestos Abatement Plan #
Type of Notification (check one) |
Original Revised |
Cancelled |
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Owner Information |
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Facility Owner |
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Street Address |
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City, State, Zip Code |
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Contact Name |
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Asbestos Contractor Information |
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Contractor Name |
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Street Address |
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City, State, Zip Code |
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Phone |
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RI License # LAC - |
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Type of Operation (check one) |
Demo |
Ordered Demo |
Renovation |
Emergency Renovation |
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Facility Description |
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Building Name |
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Street Address |
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City, State, Zip Code |
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Site Location |
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Building Size (square feet) |
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Number of Floors |
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Age in Years |
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Present Use |
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Prior Use |
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Asbestos Detection Procedure / Analytic Method (check all that apply)
PCM PLM TEM Other
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Asbestos Quantity |
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RACM to be Removed |
Category I |
Category II |
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Pipes (linear feet) |
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Surface Area (square feet) |
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Facility Components (cubic feet) |
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Asbestos Removal Schedule |
Start Date |
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End Date |
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Not Applicable (skip to next section) |
Start Date |
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End Date |
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Description of Planned Demolition / Renovation Work and Methods
Description of Work Practices / Engineering Controls to Prevent Emissions of Asbestos at the Demolition / Renovation Site
FORM |
Page 1 |
PREVIOUS VERSIONS OBSOLETE |
Waste Transporter #1
Name
Street Address |
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City, State, Zip Code |
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Waste Transporter #2 |
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Name |
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Street Address |
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City, State, Zip Code |
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Waste Disposal Site |
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Name |
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Street Address |
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City, State, Zip Code |
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Government Agency Information
In accordance with the Rhode Island Rules and Regulations for Asbestos Control
Asbestos Abatement / Demo Ordered by Government Agency |
Not Applicable (skip to next section) |
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Agency Name |
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Person Issuing Order |
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Title |
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Date Order Issued |
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Final Compliance Date Required by Order |
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Emergency Renovations
In accordance with
Sudden, unexpected event took place on: Date
Event Description
Not Applicable (skip to next section) Time
Explanation of how event caused unsafe conditions or would cause equipment damage or unreasonable financial burden
Unexpected Asbestos Procedures Description of procedures to be followed in the event that unexpected asbestos is found or previously
Certifications
As building owner/representative, I certify that an individual trained in the provisions of this regulation [Code of Federal Regulations, 40 CFR Part 61, Subpart M] will be on site during the demolition or renovation and evidence the required training has been accomplished will be available for inspection during normal business hours. I further certify that the above information is correct.
Print Name |
Signature |
RI License # |
Date |
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FORM |
Page 2 |
PREVIOUS VERSIONS OBSOLETE |
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Form Specifications
| Fact Name | Details |
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| Submission Deadline | This form must be submitted 10 working days before on-site work begins. |
| Submission Methods | Submit the form in person, by fax (401-222-2456), or through email to asbestos@health.ri.gov. |
| Governing Law | The form is governed by the Rhode Island Rules and Regulations for Asbestos Control (R23-24.5-ASB). |
| Type of Notification | Check one: Original, Revised, or Cancelled. |
| Asbestos Contractor Information | Contractor details, including name, address, and RI License #, must be provided. |
| Asbestos Detection Methods | Check all applicable methods: PCM, PLM, TEM, or Other. |
| Emergency Renovations | In accordance with R23-24.5-ASB Section A.4.2, report sudden, unexpected events. |
| Unexpected Asbestos Procedures | Describe procedures for handling unexpected asbestos or crumbled materials. |
| Certifications | The owner must certify that a trained individual will be on site during the work. |
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