part l: experience statement for demolisher (medium rise) · part l: experience statement for...

PRACTITIONER FORM

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Part L: Experience Statement for Demolisher (medium rise)

If you are applying to be registered as a building practitioner in the

Demolisher (Medium Rise) class of building work, use this form to

tell us about your Demolisher (Medium Rise) work experience.

FOR TABLE 1

You must supply details for at least five different projects, each up to five

storeys in height:

• At least one of the projects must have related to demolishing the

whole building.

• At least three of the buildings must have required removal of

hazardous materials.

• At least two of the buildings must have been commercial buildings

(in classes 2–9 of the Building Code of Australia).

For some items, you must attach certified copies of documents.

FOR TABLE 2

Please consider all demolition work that you have done on projects of up to five storeys:

• Tick each area of work that you have done.

Remember

• Please include as much detail as possible, because this statement will be usedto work out whether you have enough experience for registration.

• In your application, you will need to provide references to confirm you havecompleted this work.

• It is an offence under section 246 of the Building Act 1993 to give any false or

misleading statement or information in your application.

• To meet the experience requirements for registration, you don’t need to have

done all the work items listed in column 1 of table 2. But you do need

experience in most of them.

• We will return your application if this statement is incomplete or doesn’t haveenough detail, and ask you for more information.

• For each ticked area of work, tick how many times you have done that work.

• For each ticked area of work, list your main responsibilities for that work.

© State of Victoria, Victorian Building Authority 2017 (published September 2017)

Statement of Experience for Demolisher (medium rise) work - /13

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Table 1. Fill out this table to describe your project history

Brief description

Period of work (must

include actual dates)

Work address (or where work

was undertaken)

Name and contact number of

your employer

Building permit

number

Project 1

Number of storeys:

Whole building or part

building:

Commercial or residential:

Start date:

End date:

Project

2

Number of storeys:


building:


Start date:

End date:

Project

3

Number of storeys:


building:


Start date:

End date:


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3

Project 4

Number of storeys:


building:


Start date:

End date:

Project

5

Number of storeys:


building:


Start date:

End date:

Please continue next page


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Table 2. Fill out this table for all work that you have done

What type of work have

you done? Tick the box.

How many times

have you done

this type of work?

Tick the box. What were your exact responsibilities? List in point form.

A. Scoped and costed demolition work

Undertook site visits to

scope the size and nature of

demolition work required,

and to identify potential

hazards

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+.

Liaised with client and

others to scope the work ☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+.


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Liaised with potential suppliers of related services

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+.

Identified site and work

related hazards and

developed measures to

control risks

You must attach a copy of

the SWMS

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

B. Prepared demolition quotes

You must attach copies of

the relevant documents

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

C. Applied for, obtained

and complied with a permit

to demolish a building



☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .


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D. Prepared a work plan

documenting precautions to

be implemented and

procedures for undertaking

the demolition work

You must attach a copy of

the work plan

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

E. Undertook site mobilisation activities

Identified services, and

located and arranged for

the abolishment of services

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Arranged for building or

structure to be cleared of

asbestos containing

materials (ACM) before

demolition work began

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .


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Understood the need to

investigate sites for other

contaminants

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Investigated the site for

underground tanks and

arranged for their safe

removal

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

F. Ensured the safety of the site and workers during demolition

Provided for medical

attention in the case of

serious injury

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .


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Ensured compressors,

jackhammers and other

pneumatic tools were

properly maintained and

fully serviceable

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Ensured workers used

correct Personal Protective

equipment (PPE) (e.g.

hearing protection,

breathing masks, protective

glasses, head shields,

gloves, or rawhide

boilermaker’s jackets to

prevent burns)

Confirmed arrangement of adequate fall protection

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .


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Erected appropriate

hoardings, gantries and

overhead protection

barriers to protect the

public and the personnel on

site

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

G. Demolished low rise buildings using suitable processes and techniques

Used the tools appropriate for manual demolition

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Understood the standard

construction types or

methods used for buildings

up to five storeys

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .


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Used the standard

(excavator) attachments

normally associated with

demolition

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Used the support systems

normally encountered in

domestic and commercial

construction

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Used protection measures

for adjoining properties or

the general public

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .


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H. Capacity to enter into and administer appropriate contracts

Drafted contracts for

demolition work to be

undertaken by a registered

building practitioner



☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Administered contracts on

behalf of a registered

building practitioner



☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .


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I . Arranged for and carried out appropriate waste disposal

Identified and arranged for the safe and legal disposal of hazardous and asbestos containing materials

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Safely salvage identified materials, fixtures or fittings from demolition projects

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .

Identified, sorted and arranged for the transfer of materials for recycling and/or landfill

☐ 1 – 5

☐ 6 – 10

☐ 11 – 20

☐ 20+ .


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Remember: The information provided in this form must be true and correct. It is an offence under section 246 of the Building Act 1993 to give false or

misleading information in relation to an application for registration, and this offence carries a maximum penalty of 120 penalty units.

I declare that the information contained in this form is complete and true to the best of my knowledge. And I understand that the VBA may make enquiries

to verify any of the information I have given on this form, and I consent for the information provided in this form to be shared with any other third party

for that purpose.

Applicant name

Applicant signature

Date


(must be a handwritten signature)

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