Dust Mitigation Plan Form PDF Details

A Dust Mitigation Plan is a written plan that outlines specific steps to be taken to prevent or minimize the amount of dust created during construction or renovation. The purpose of a Dust Mitigation Plan is to protect workers, the public, and the environment from exposure to hazardous dust. A well-developed Dust Mitigation Plan can also help ensure compliance with regulatory requirements and improve safety in the workplace. If you are involved in a construction or renovation project, it is important to develop a Dust Mitigation Plan before work begins. This article provides an overview of what should be included in a Dust Mitigation Plan and explains how to get started.

QuestionAnswer
Form NameDust Mitigation Plan Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesnyc dust mitigation plan form, noise mitigation form, nyc dep dust mitigation form, dust mitigation plan

Form Preview Example

DUST Mitigation Plan

FORM

September 23, 2009*

It is not necessary to file this document with DEP

however, it must be accessible to inspectors.

The responsible party shall be liable for the accuracy of the document and compliance with

all applicable rules in 15 RCNY Chapter 13.

IGeneral Introduction

All persons constructing or operating a large article, machine, device, equipment, such as a rock crusher, or other contrivance or facility capable of causing or permitting emission of dust into the atmosphere at a construction site shall keep on site a document detailing such equipment . Information provided on this document shall include the ownership, location, design, make and model, operation, i.e. how does it operate, as well as any other pertinent information requested by the Department. In addition, the measures utilized to reduce dust emissions resulting from the use of these items as set forth in 15 RCNY 13-01 et seq. shall be clearly outlined. This document shall be attached as an addendum sheet to the Noise Mitigation Plan prepared pursuant to Section 24-220 of the Noise Code.

IIContact Information

Name of Responsible Party as defined in 15 RCNY §28- 109___________________________________________

Work Site Location with Borough

(BLOCK/LOT/Address)__________________________________

Contact Phone Number of Responsible Party________________________

IISpecialized Equipment

1.Common or Brand Name_______________________________

2.Make______________________________________

3.Model______________________________________

4.Type (i.e. rock crusher)_______________________________________

5.Owner________________________________________

6.Lease !YES NO!

7.Rental YES! NO!

8.Describe Use on Site

________________________________________________

_________________________________________________

__________________________________________________

__________________________________________________

9.Dust Control Measures Used with Equipment

_______________________________________________

______________________________________________

______________________________________________

________________________________________________

IIIAdditional Dust Control Measures that will be employed at site

!Wetting

Describe the process i.e. handheld hoses; wheel wash station; automated sprinkler system

______________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

!Appropriate Spraying Methods

________________________

________________________

________________________

________________________

!Trucks Covered

YES!

NO!

!Adequate and continuous supply of water delivered to the construction site under proper pressure and distributed by a hose system and terminating in suitable water sprays or jets. !Portable hand water sprinklers or hose sprinklers are acceptable means of wetting for dust control.

!Suitable drainage means shall be provided for the removal of water and sludge which drains from the operation.

!Prior to the commencement of demolition activities, all exterior surfaces of a building up to six stories in height shall be wetted.

!All construction material shall be sufficiently wetted to prevent dust from becoming airborne before loading into trucks.

!Wetting shall be used to control dust where drilling, grinding, or other similar construction activities occur.

!Sprinklers or other effective means shall be provided to control dust produced at dumps, conveyors, chutes, and other transfer points.

!Soil or debris piles shall be moistened if dust is being emitted from the piles due to prevailing winds and not from a momentary gust.

!Where the demolition or renovation of any building or other structure is being performed by hand, debris, bricks, and other material shall be removed by means of chutes, by means of buckets or hoists.

!During sandblasting or other similar operations, installation and use of hoods, fans and dust collectors to enclose and vent shall be used.

!Earth moving equipment or erosion is required daily when there is removal of earth or other material from paved roads.

!Dust and debris from the demolition operations shall be removed daily from the adjacent streets, sidewalks and alleys.

*Use latest version of the plan which can be found on the DEP Website at www.nyc.gov/dep/html/airnoise.html.

I ______________________ of the ________________hereby certify the information contained

(Name of Responsible Party)

(Company)

in the form is true and accurate.

________________________ ______________________

SignatureDate

_____________________________

NOTARY PUBLIC

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Writing part 1 in construction dust mitigation plan

2. Given that this segment is finished, it's time to put in the necessary particulars in Common or Brand Name Make Model so you're able to move forward to the next step.

Filling in segment 2 of construction dust mitigation plan

3. This part is going to be simple - fill out all the form fields in Dust Control Measures Used with, Additional Dust Control Measures, and III Wetting Describe the process to finish this part.

construction dust mitigation plan conclusion process described (step 3)

4. Filling out YES NO, and III Wetting Describe the process is crucial in this fourth section - you'll want to invest some time and fill in each and every empty field!

Completing section 4 of construction dust mitigation plan

5. The document must be finished within this section. Below one can find an extensive listing of form fields that require accurate details for your form usage to be accomplished: During sandblasting or other, and Date.

construction dust mitigation plan completion process outlined (part 5)

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