A & R Hepburn Engineering

• Conducted on

  Date

• Prepared by

• Date

  Date

• Standard/Arranged

• Cold call

Referral Source

• Source

  Select Email Phone Call Letter Other

  • Email
  • Phone Call
  • Letter
  • Other

Tenant/Homeowner Details

• Name

• Address
  Address

• Phone Number

• Mobile Number

• Email Address

• Preferred Time of Contact

  Select Morning Afternoon Evening Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Morning
  • Afternoon
  • Evening
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

• Preferred Contact Method

  Select Landline Mobile Email Letter

  • Landline
  • Mobile
  • Email
  • Letter

Client/Landlord Details

• Name

• Address
  Address

• Phone Number

• Mobile Number

• Email Address

• Preferred Method of Contact

  Select Email Phone Call Letter Other

  • Email
  • Phone Call
  • Letter
  • Other

• Preferred Time of Contact

  Select Morning Afternoon Evening Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Morning
  • Afternoon
  • Evening
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

Property Details

• Property Type

  Select Mid-Terrace End terrace Semi-detached Detached Lower Flat Middle Flat Top Flat Masonette Other

  • Mid-Terrace
  • End terrace
  • Semi-detached
  • Detached
  • Lower Flat
  • Middle Flat
  • Top Flat
  • Masonette
  • Other

• Building finish

• Number of Bedrooms

• Type of Heating

  Select Gas Oil Solid Fuel Electric Other

  • Gas
  • Oil
  • Solid Fuel
  • Electric
  • Other

• Insulation Works Required

  Select Loft Insulation Cavity Wall Insulation Draught Proofing Extraction Underfloor Insulation Internal Wall Insulation Spray Foam Insulation

  • Loft Insulation
  • Cavity Wall Insulation
  • Draught Proofing
  • Extraction
  • Underfloor Insulation
  • Internal Wall Insulation
  • Spray Foam Insulation

• Structural condition

  Safe

  At Risk

  N/A

• External Wall Condition

  Sound

  Un-sound

• Remedial works required

  Yes

  No

• Adequate ventilation to work area

  Yes

  No

  N/A

• Dampness or water damage

  Yes

  No

• Photo of each elevation

  Media

• Building defects

  Yes

  No

• Protected species or rodents

  Yes

  No

• Safety monitors present

  Select Smoke Alarm Fire Alarm CO2 Alarm Cold Alarm

  • Smoke Alarm
  • Fire Alarm
  • CO2 Alarm
  • Cold Alarm

• Have the alarms all been tested by surveyor

• Special Instructions

Access

• On site parking

• Client Instructions

• Access Issues

  Yes

  No

• Access Equipment Required

  Select None Ladders Tower Scaffolding Cherry Picker Scissor lift Spider Conservatory Ladder

  • None
  • Ladders
  • Tower
  • Scaffolding
  • Cherry Picker
  • Scissor lift
  • Spider
  • Conservatory Ladder

• Photo of loft

  Media

• Area to be insulated

• Existing Depth

  Select 0mm 50mm 70mm 100mm 150mm 200mm 250mm 270mm 300mm

  • 0mm
  • 50mm
  • 70mm
  • 100mm
  • 150mm
  • 200mm
  • 250mm
  • 270mm
  • 300mm

• Photo of existing depth

  Media

• Depth to be added

  100mm

  150mm

  200mm

  250mm

  300mm

• Loft drawing

  Drawing

• Relay Required

  Yes

  No

• Please note any pipe work that required lagging

• Loft hatch needing D/P

  Yes

  No

• Loft vents required

  Yes

  No

• Areas to be omitted

  Yes

  No

• Walkway required

  Yes

  No

• Loft clearance

  Yes

  No

• Additional notes

Details

• Total area to be insulated

• Required material

  SIG Supafil 40

  SIG Carbon +

  Rockwool

  Thermabead

  Technitherm

• Average Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Total area to be omitted

• Photos of omitted areas

  Media

• Number of air bricks

• HTT reason

• Number of Cavity brushes required

• Core vent required

  Yes

  No

• Photo of any defects

  Media

• List any defects

• List all access issues

• Photo of access issues

  Media

• Location of chimneys

  Select Internal External Front Elevation Rear Elevation Left Hand Elevation Right Hand Elevation None

  • Internal
  • External
  • Front Elevation
  • Rear Elevation
  • Left Hand Elevation
  • Right Hand Elevation
  • None

• Location of flue

  Select Internal External Front Elevation Rear Elevation Left Hand Elevation Right Hand Elevation None

  • Internal
  • External
  • Front Elevation
  • Rear Elevation
  • Left Hand Elevation
  • Right Hand Elevation
  • None

Front Elevation

• Boroscope photo

  Media

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Elevation Drawing

  Drawing

Rear Elevation

• Boroscope photo

  Media

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Elevation Drawing

  Drawing

Right hand elevation

• Boroscope photo

  Media

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Elevation Drawing

  Drawing

Left hand elevation

• Boroscope photo

  Media

• Cavity Depth

  Yes

  No

  N/A

• Elevation Drawing

  Drawing

• Total area to be extracted

• Reason for extraction

• Material being extracted

  Bead

  White Fibre

  Yellow Fibre

  Rockwool

  Foam

• Recommended cavity drying time

• Are all apertures sealed internally

  Yes

  No

• Moisture reading results

• Has client been advised on extent on drilling and core holes

  Yes

  No

  N/A

• Area to be sprayed

• Product to be sprayed

  Pirthane

  Duratherm

  Agritherm

• Photo of area to be sprayed

  Media

• Depth of joists

• Depth to be sprayed

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Finish to be applied

  Select None FPC EMA Plained

  • None
  • FPC
  • EMA
  • Plained

• Adequate ventilation

  Yes

  No

  N/A

• Special instructions

• Loft hatch

  Select Brown White Bottom Brush O Tube Letterbox Cover 1 2 3 4 5 6 7 8 9 10

  • Brown
  • White
  • Bottom Brush
  • O Tube
  • Letterbox Cover
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Internal Door

  Select Brown White Bottom Brush O Tube Letterbox Cover 1 2 3 4 5 6 7 8 9 10

  • Brown
  • White
  • Bottom Brush
  • O Tube
  • Letterbox Cover
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• External Door

  Select Brown White Bottom Brush O Tube Letterbox Cover 1 2 3 4 5 6 7 8 9 10

  • Brown
  • White
  • Bottom Brush
  • O Tube
  • Letterbox Cover
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Standard window

  Select Brown White Bottom Brush O Tube Letterbox Cover 1 2 3 4 5 6 7 8 9 10

  • Brown
  • White
  • Bottom Brush
  • O Tube
  • Letterbox Cover
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Sash windows

  Select Brown White Bottom Brush O Tube Letterbox Cover 1 2 3 4 5 6 7 8 9 10

  • Brown
  • White
  • Bottom Brush
  • O Tube
  • Letterbox Cover
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• HAZARD
  Injury to employees and public
  POTENTIAL
  Slips, Trips, Falls
  EXISTING RISKS
  Medium
  CONTROL MEASURE
  H&S checklist, Good Housekeeping, Safety Signage
  REVISED RISK
  Low

• HAZARD
  Working at height
  POTENTIAL
  Falls, Material falls
  EXISTING RISK
  Medium/long ladder, Free standing
  CONTROL MEASURE
  Complete daily checklist, Correct use of ladder, Safety signage
  REVISED RISK
  Low

• HAZARD
  Signage control
  POTENTIAL
  Public intrusion into work area
  EXISTING RISK
  High
  CONTROL MEASURE
  Signage, Barrier use
  REVISED RISK
  Medium

• HAZARD
  Access arrangements
  POTENTIAL
  Falls, Cuts, Damage
  EXISTING RISK
  Medium
  CONTROL MEASURE
  Survey inspection
  REVISED RISK
  Medium

• HAZARD
  Non-floored loft
  POTENTIAL
  Trips, Property damage, Knee injury
  EXISTING RISK
  High
  CONTROL MEASURE
  Crawl boards, Knee pads, Ceiling weight checked at survey
  REVISED RISK
  Medium
  
  

• HAZARD
  Substance hazard
  POTENTIAL
  Vapour, Dust, Inhilation, Skin contamination
  EXISTING RISK
  High
  CONTROL MEASURE
  PPE use, Face masks
  REVISED RISK
  Low

• HAZARD
  Manual handling
  POTENTIAL
  Personal injury
  EXISTING RISK
  Medium
  CONTROL MEASURE
  PPE, Correct manual handling technique
  REVISED RISK
  Low

• HAZARD
  Lone working
  POTENTIAL
  Illness, Injury
  EXISTING RISK
  High
  CONTROL MEASURE
  Phone use, Local emergency contacts, First aid kit
  REVISED RISK
  Medium

• HAZARD
  Drilling
  POTENTIAL
  Debris injury
  EXISTING RISKS
  High
  CONTROL MEASURE
  Eye protection, Correct PPE
  REVISED RISK
  Medium

• HAZARD
  Visibility
  POTENTIAL
  Falls, Trips, Errors
  EXISTING RISK
  High
  CONTROL MEASURE
  Use correct lights, Daily checklist
  REVISED RISK
  Low

• HAZARD
  Loose electric cables, pipe work
  POTENTIAL
  Shocks, Trips, Falls, Snags
  EXISTING RISKS
  High (where present)
  CONTROL MEASURE
  Inform client, Ensure power off, Make secure
  REVISED RISK
  Low

• HAZARD
  Material injection
  Sand/cement use
  POTENTIAL
  Harmful if ingested, Mess, Foot injury (Weight)
  EXISTING RISKS
  Medium
  CONTROL MEASURE
  Safety boots, Gloves
  REVISED RISK
  Low

• HAZARD
  Vibration
  POTENTIAL
  VWF, Personal injury
  EXISTING RISKS
  High
  CONTROL MEASURE
  Correct grip, PPE use
  REVISED RISK
  Medium

• HAZARD
  Birds/bees/wasps nests
  POTENTIAL
  Personal injury
  EXISTING RISKS
  High
  CONTROL MEASURE
  Inform client, Arrange removal
  REVISED RISK
  Low

• HAZARD
  Asbestos
  POTENTIAL
  Exposure, Illness
  EXISTING RISK
  High
  CONTROL MEASURE
  Asbestos survey
  REVISED RISK
  Low

• HAZARD
  Hand tools
  POTENTIAL
  Cuts, Bruises, damage to clothing
  EXISTING RISKS
  Medium
  CONTROL MEASURE
  Knife sheath, Daily checks
  REVISED RISK
  Low

• HAZARD
  Confined spaces
  POTENTIAL
  Back injury, breathing
  EXISTING RISKS
  Medium
  CONTROL MEASURE
  Regular breaks, Correct PPE
  REVISED RISK
  Low

• HAZARD
  Machinery
  POTENTIAL
  Electrocution, Limb injury
  EXISTING RISKS
  High
  CONTROL MEASURE
  Due servicing, Daily checks
  REVISED RISK
  Medium

• HAZARD
  Noise
  POTENTIAL
  Hearing damage, Disturbance
  EXISTING RISKS
  High
  CONTROL MEASURE
  Ear defenders, Notification
  REVISED RISK
  Low/Medium

• HAZARD
  Parking
  POTENTIAL
  Public injury, Vehicle damage
  EXISTING RISKS
  Medium
  CONTROL MEASURE
  Due care, Use banksman
  REVISED RISK
  Low

• HAZARD
  Dust (drilling)
  POTENTIAL
  Breathing problems, Mess
  EXISTING RISKS
  Medium
  CONTROL MEASURE
  Mask use, Proper cleaning
  REVISED RISK
  Low/Medium

Dynamic Risk Assessment

• I have assessed the conditions on site ensuring there is adequate ventilation and no evidence of damp and no remedial works required. Unless listed below, there are no additional significant hazards observed that are not addressed in the generic risk assessment for the work to be undertaken.

  None

  See Below

• Surveyor signature

  Sign

Tenant/Homeowner health & safety pre-start checks and information

• Is there a tenant/homeowner present

  Yes

  No

• If yes ensure that the full scope of work that is due to be carried out is fully explained

• Ensure that the tenant/homeowner is fully aware of all the work activities (including areas to be omitted) and safety issues relating to parking, the working are, hazards, equipment being used, noise and waste

• I have been made fully aware of all the work activities (including the ares to be omitted) due to take place at my property

• I have been made fully aware of the hazards associated with the work and where applicable, all the additional safety measures that will have to be taken

• I agree to the works being carried out

• Client signature

  Sign