Title Page
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Site Name:
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Site Address:
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Site Postcode:
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Surveyed by (Engineer Name):
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Date of Survey:
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Tesseract Number:
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Insert photograph of building elevation 1
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Insert photograph of building elevation 2
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Insert photographs of property in relation to surrounding area
Dish and Aerial Install
EXTERNAL WORKS
Location of Dish and Aerial - Description
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Note: Wherever possible avoid front of building, do not obstruct windows or doors and do not detract from logo's, signage etc
Dish Installation
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Are there existing satellite dishes or aerials on the site?
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Please give details
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Are they connecting to any existing LPS?
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Describe fully the proposed location for dish and aerial location
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Insert and mark-up photograph showing location
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Describe access to this dish/aerial location for both installation and service calls
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Describe accurately the means of safely anchoring yourself and others during the installation any specific PPE equipment required
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Describe size of mount required (diameter, length, height, standoff etc):
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Insert line of sight photograph
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Is the full arc viewable from this position?
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Which satellites are affected?
- 42.0° East
- 36.0° East
- 33.0° East
- 28.2° East
- 19.2° East
- 13.0° East
- 9.0° East
- 4.8° East
- 1.0° West
- 5.0° West
- 7.0° West
- 12.5° West
- 15.0° West
- 24.5° West
- 30.0° West
- 37.5° West
- Other
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State obstructions
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Insert and mark-up photograph showing obstructions
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Can the dish/aerial location be viewed by higher buildings?
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Describe buildings overlooking proposed location
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Insert photograph showing overlooking buildings
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Is the proposed location considered secure?
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Describe the reasons why this location is not considered secure
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Is there possibility of future blockage to dishes/aerials caused by trees or building works?
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Give details
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Insert photograph showing potential future blockage
Aerial Installation
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State TV Transmitter:
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Wideband or Grouped aerial required?
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Type of Aerial required:
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State aerial type required:
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Mount Type:
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Describe type of mount required:
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Describe size of mount required (diameter, length, height, standoff etc):
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Is a Masthead amp and psu required?
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State gain (dB) of masthead amp required:
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Details of building structure at dish position
- Brick
- Stone
- Concrete
- Asphalt
- Cladding
- Other
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Describe building structure
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Condition of building structure
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Describe condition of building structure and how the mounts are going to be securely affixed (eg chem fixings)
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Do dishes/aerials and mounts need to be connected to the sites' existing Lightening Protection System?
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Describe what is required to bond the dishes/aerials and mounts to the existing LPS
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Ladders required?
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State size required
- T12
- T14
- T16
- T18
- T20
- T22
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Cherry picker required?
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Please give details
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Is scaffold required?
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Please give details
Cable Install
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Describe cable route from the proposed location to rack position
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Insert and mark-up photographs showing cable route from this proposed location to headend/receiver position (external and internal routes)
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Will wall penetration be required for the cable?
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If Yes, give details of hole size, wall thickness and sealant required
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Insert and mark-up photograph showing cable entry point
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Cable type required:
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Number of cable runs from this dish required:
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Trunking or conduit required?
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Give details
Health and Safety
a) Working at Heights
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A. IS THERE ANY WORKING AT HEIGHT?
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A1. RISK OF FALLS FROM HEIGHTS USING LADDERS AND ACCESS EQUIPMENT?
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Harm - Serious Injuries or Death
Persons at risk - Operatives / Members of the public
Risk rating - High
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Control measures to be implemented - All operatives must have a valid working at heights certificate. Ladders must be in good condition and set on level ground at the correct angle (1 in 4). Where this cannot be achieved, additional stabilising devices must be employed. All ladders to be secured by eye bolts and straps.
Safety harnesses must be worn and attached using rope and grab when three points of contact cannot be maintained.
Safety boots must be worn for ankle support and protection.
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Residual risk - Medium -
Additional Control Measures Required:
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A2. RISK OF FALLS FROM HEIGHT WHEN USING SCAFFOLDING?
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Harm - Serious Injuries or Death
Persons at risk - Operatives / Members of the public
Risk rating - High
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Control measures to be implemented - Operatives must under no circumstance access a incomplete scaffold unless it has been inspected by a competent person and tagged I to say it is "safe to use"(This must be done every 7 days). Scaffold must only be altered/erected by a company approved/competent person. If in any doubt, contact a member of the Health & Safety Department.
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Residual risk - Medium -
Additional Control Measures Required:
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A3. WORKING ON AN UNPROTECTED FLAT ROOF?
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Harm - Falls from height, Serious injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - When no edge protection is provided, a 2 metre exclusion zone must be set up . To work within the 2 metre exclusion zone, operatives must be attached to dead mans anchor then from the anchor a fixed lanyard rope system is used.. If access for man anchor is not available, suitable anchor points shall be identified and restraint system implemented. If in doubt contact the Health and Safety Department.
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Residual risk - Medium -
Additional Control Measures Required:
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A4. WORKING ON A FLAT ROOF THAT HAS ROOF PROTECTION?
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Harm - Falls from height, Serious injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - When working on a roof that has edge protection, this must be at least 950mm high as a minimum requirement. If you are unsure, then contact project manager or Health & Safety Department for further advice/guidance.
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Residual risk - Medium -
Additional Control Measures Required:
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A5. EXIT ONTO THE ROOF WITHIN 2m OF ROOF EDGE?
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Harm - Serious Injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Operatives are to attach to a suitable anchorage point via fixed or inertia lanyard to operate as fall restraint from unprotected edges.
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Residual risk - Medium -
Additional Control Measures Required:
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A6. ACCESSING A FLAT ROOF THAT DOES NOT HAVE ANCHOR POINTS?
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Harm - Falls from height, Serious injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - A mobile man anchor (MMA) must be used and positioned at least 2.5metres from any open edge or void. MMA must only be used where access allows and where the roofs integrity is capable of withstanding the weight . MMA must not be placed in locations where standing water is present or used in icy conditions. Operatives must attach work/safety lines or lanyards to the anchor point on the (MMA). Fall restraint must be used by operatives before entering 2m exclusion zone . NO EXCEPTIONS. Safe lifting and carrying techniques to be used and manual handling aids used where possible. Operatives are trained in the safe use of MMA.
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Residual risk - Medium -
Additional Control Measures Required:
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A7. RISK OF FALLS FROM HEIGHT WHILST ON A PITCHED ROOF?
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Harm - Serious injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Cat ladders must be used on all pitched roof works. Access ladders must extend 1.2 metres above gutter line and must be secured at the top with a stand off and bottom with ratchet straps, stabiliser and eye bolts. Cat ladder must span the roof fully, have a rope system attached and be strapped to the access ladder.
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Residual risk - Medium -
Additional Control Measures Required:
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A8. RISK OF FALLS FROM HEIGHT WHILST ON A PITCHED ROOF WITH NO APEX?
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Harm - Serious injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Operatives to use a rope safety line attached to eyebolts at each end of the roof. Safety harnesses to be attached to safety line at all times whilst working on roof. Work must cease in wet or windy conditions.
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Residual risk - Medium -
Additional Control Measures Required:
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A9. UNSAFE GROUND CONDITIONS (ie UNEVEN OR SOFT)?
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Harm - Serious injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Levelling device to be used on ladder where ground is uneven. Use designated pathways. If unable to do this please contact your Project Manager.
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Residual risk - Medium -
Additional Control Measures Required:
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A10. LOFT WORK?
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Harm - Falls from height, Serious injuries or Death from falling through ceiling
Persons at risk - Operatives / Residents in block
Risk rating - High
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Control measures to be implemented - Lofts should be checked for integrity before entering. Where walkways are available, these must be kept to. If no walkways or boarded areas then crawl boards may be required to undertake activities in the loft. Lighting will be needed to reduce risk of injury. Face masks, Hard hats , Hi Viz, gloves , goggles & dust masks to be worn at all times. Possible breathing apparatus may be required.
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Residual risk - Medium -
Additional Control Measures Required:
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A11. ACCESSING A LOFT WITHOUT AN INTERNAL LOFT LADDER?
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Harm - Falls from height, Serious injuries or Death
Persons at risk - Operatives / Members of the public
Risk rating - High
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Control measures to be implemented - If we need to access the loft then at survey stage a request is to be made to the client that he supplies one that is fit for purpose. If this is not possible then a extendable ladder should be used provided it can be secured to the wall via a eyebolt & ratchet strap or held at the base by a second person. Signage, cones and warning tape must be used at the base of the entry point. Ensure that prior to entry that there is adequate lighting and the loft can sustain your weight. If unsure seek advice from the Project Manager responsible.
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Residual risk - Medium -
Additional Control Measures Required:
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b) Access equipment (works with MEWP)
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IS A CHERRY PICKER OR SCISSOR LIFT (MEWP) REQUIRED?
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B1. OPERATING MEWP?
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Harm - Falls from heights, Serious injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Only competent and trained personnel holding valid certification to operate equipment. It must be fully tested and hold current certification to operate equipment. It must be fully tested and hold current certification. Equipment risk assessment to be read, understood and signed by operatives. It must be read, understood, signed by operatives. It must be made available on equipment at all times. All equipment shall be maintained to LOLER Regulations. Operator must carry out pre-start checks as per training. No materials to hang over the platform handrail. Operator must not hang over handrail and equipment must not be over loaded. Operations must cease in adverse weather including high winds, driving rain, thunder and lightning.
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RESIDUAL RISK - Medium -
Additional Control Measures Required:
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B2. SITING AND SETTING UP OF MEWP?
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Harm - Falls from Height, serious injuries or death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Machine set up and levelled in accordance with manufacturer’s instructions. Suitable firm level ground conditions with no slopes, underground services, man holes or obstructions. Outriggers/stabilisers used properly and set up with spreader pads utilised as necessary to spread load and prevent sinking. Ground conditions should be monitored at all times. During set up and once established, the work area must be maintained and unauthorised access prevented using cones, barriers and barrier tape. Use on pavements should be avoided where possible to minimise damage to underground services If working in public highway compliance with New Roads and Street Works Act 1991 must be followed. When parked, MEWP must be left in a safe place, all electrics isolated and keys held by operator.
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RESIDUAL RISK - Medium -
Additional Control Measures Required:
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B3. ACCESSING A FLAT ROOF USING MEWP?
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Harm - Falls from Height, serious injuries or death
Persons at risk - Operatives / Members of the public
Risk rating - High
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Control measures to be implemented - MEWP must be operated by trained competent person. All areas below must be segregated from members of the public by means of signage and physical barriers. The MEWP arm must be fully extendable and be placed a suitable distance away from the edge of the roof. Suggest approx 2 meters. The operatives must be kept attached via a fixed lanyard at all times including exiting the basket until a safe distance can be maintained
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RESIDUAL RISK - Low -
Additional Control Measures Required:
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B4. OVERHEAD LINES (STRIKING OF ELECTRICITY LINES)?
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Harm - Striking electrical cables / electrocution
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Area to be assessed at survey stage if possible. Under no circumstance must equipment be used in the vicinity of overhead lines unless otherwise stated. Ensure work area is clear of any temporary power lines that may be being run and that MEWP cannot come into contact with any power lines. If unsure, do not start work and seek advice from Project Manager.
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RESIDUAL RISK - Low -
Additional Control Measures Required:
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c) Environment and Exposure
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C1. Asbestos exposure
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Harm - Ill health from exposure to asbestos
Persons at risk - Operatives / Members of public
Risk rating - High
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Control measures to be implemented - If asbestos is suspected in the area you are working, work must be stopped immediately and reported to project management. Works will only continue when an asbestos survey of the affected work area has been carried out by a competent person/company and is either declared safe to work in or an alternative method of working has been found. The clients asbestos register must be scanned in the specific areas before any further works are undertaken
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Residual risk - Low -
Additional Control Measures Required:
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C2. Dust exposure
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Harm - Ill health from exposure to dust inhalation
Persons at risk - Operatives / Members of public
Risk rating - Medium
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Control measures to be implemented - Face masks must be worn at all times whilst drilling or working in dusty environments. Work area must be cordoned off by means of cones, barrier tape and warning signage to warn people of works taking place. Where dust masks are provided operatives will undergo face fit testing.
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Residual risk - Low -
Additional Control Measures Required:
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C3. Presence of needle injuries inside properties and buildings
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Harm - Needle injuries, possibility of contracting serious diseases
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Operators to be extra vigilant and cautious when working in properties and buildings. If needles are found, work must stop immediately. You must inform Project Management and leave the area. If injuries are sustained, you must attend the nearest hospital immediately.
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Residual risk - Medium -
Additional Control Measures Required:
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C4. Environmental hazards/Bees/Wasps/Vermin and hazardous waste
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Harm - Potential of contracting various diseases
Persons at risk - Operatives / Members of the public
Risk rating - High
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Control measures to be implemented - If any environmental hazards such as wasps/bees nests/vermin/ hazardous waste etc are discovered, then work is to stop immediately and contact client/office to instigate a competent contractor to remove hazard.
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Residual risk - Low -
Additional Control Measures Required:
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C5. Un-cooperative residents or members of the public
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Harm - Possibility of being attacked by abusive resident or member of public
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Operative to avoid confrontation with residents/members of the public and walk away from situation. This must be reported to management and the Health & Safety Department Immediately
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Residual risk - Low -
Additional Control Measures Required:
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C6. Weather conditions (i.e severe gales or snow etc.)
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Harm - Falls from height, Serious injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - In the event of excessive weather work will be stopped specifically high winds on MEWP, Ladders, Cradles and roof works. Also extra care is needed when working in snow and ice. Under no circumstances should work continue in these circumstances. If significant risk is present, contact the Health & Safety Department
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Residual risk - Low -
Additional Control Measures Required:
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C7. Working in access roads, car parks or public places
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Harm - Injuries to members of the public, slips &trips or head injuries fro falling objects
Persons at risk - Operatives / Members of the public
Risk rating - Medium
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Control measures to be implemented - Operatives are to ensure that work areas are cordoned off with cones, barrier tape and suitable signage to prevent un-authorised entry. If possible try to minimise works within these areas. If working in a public highway, works must comply with the New Road Street Works Act 1991.
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Residual risk - Low -
Additional Control Measures Required:
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C8. Discovery of pirate radio aerials
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Harm - Threats of violence, possibility of being attacked
Persons at risk - Operatives / Members of the public
Risk rating - High
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Control measures to be implemented - If you discover anything to do with pirate radio, work must stop and you must leave site immediately. Contact project management immediately for further advise
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Residual risk - Low -
Additional Control Measures Required:
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C9. Overhead lines (striking of telephone or power lines)
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Harm - Serious Injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Equipment must not be used in vicinity of overhead lines. Additional care must be taken when moving ladders as to not to strike the lines. This must be a two man operation. Should the work be too close to lines, stop and contact project manager or Health & Safety Department for further advice
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Residual risk - Medium -
Additional Control Measures Required:
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C10. Working in a confined space
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Harm - Serious Injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Ensure adequate lighting is available prior to entry. Bump cap to be worn at all times whilst working in confined space to avoid head injuries. All items must be removed from the confined space before entry and a safe working area must be established.
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Residual risk - Medium -
Additional Control Measures Required:
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C11. Working in residents or communal gardens
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Harm - Serious Injuries or Death
Persons at risk - Members of the public
Risk rating - Medium
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Control measures to be implemented - Cones, barrier tape and warning signage to be in place around work area and adequate signage to be in place at all entrances, exits of the building and along all pathways.
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Residual risk - Low -
Additional Control Measures Required:
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C12. Exposure to noise from drilling or loud machinery
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Harm - Loss of hearing or partial deafness
Persons at risk - Operatives
Risk rating - Medium
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Control measures to be implemented - Hearing protection must be worn when undertaking noisy activities such as drilling. Noise levels must not exceed 85 dba. If unsure, contact project manager or Health & Safety Department for further advise.
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Residual risk - Low -
Additional Control Measures Required:
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C13. Chemical Hazards (Hazardous substances)
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Harm - Risk of burns, inhalation and ingestion
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - In order to reduce the risk of exposure to hazardous substances, the following measures will be implemented:
• An inventory of all substances hazardous to health in use by the company will be compiled and maintained together with appropriate hazard information. This can be obtained from the Health & Safety Department.
• All operatives involving, or which may involve, exposure to substances hazardous to health will be medically assessed.
• Appropriate control measures will be implemented if it is not possible to eliminate, or substitute for a hazardous substance (See separate risk assessment).
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Residual risk - Medium -
Additional Control Measures Required:
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C14. Inadequate First Aid provisions
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Harm - Sustaining Injuries
Persons at risk - Operatives
Risk rating - Medium
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Control measures to be implemented - Operatives must ensure they have a first aid box which is a minimum of a 1-10 man kit. It must be adequately stocked and meets legal compliance. Operatives must have a minimum standard of first aid training to comply with the First Aid at work regulations 1981.
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Residual risk - Low -
Additional Control Measures Required:
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C15. Fire prevention and escape routes
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Harm - Serious Injuries or Death
Persons at risk - Operatives / Members of the public
Risk rating - High
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Control measures to be implemented - Operatives must ensure before works commence that they know where the escape routes and assembly points are located. Operatives are only allowed to use fire extinguishers if they have had the necessary training. Operatives to follow site emergency procedures at all times.
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Residual risk - Medium -
Additional Control Measures Required:
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C16. Potential non-ionising Radiation exposure from transmitters on roof
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Harm - General sickness, limb weakness. nausea, headaches. flu like symptoms
Persons at risk - Operatives
Risk rating - Medium
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Control measures to be implemented - At survey stage, details shall be taken of contact number and site code to request power down of transmitter. Work shall be avoided directly in front of the mast, with signal strength generally reducing significantly from 2-5 metres. If any sickness is identified, the operative concerned must inform the client, and leave site immediately to seek further medical advice – e.g. go to local hospital.
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Residual risk - Low -
Additional Control Measures Required:
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C17. Slips and Trips
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Harm - Strains, broken legs, arms, head injuries
Persons at risk - Operatives
Risk rating - Medium
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Control measures to be implemented - Operatives to ensure that: • All work areas will be regularly inspected to ensure that good standards of “housekeeping” are maintained at all times.
• Appropriate protective clothing must be worn, especially safety footwear.
• Operatives are required to take reasonable care of their own safety when working and moving about a site. This means keeping their work area clean and tidy at all times.
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Residual risk - Low -
Additional Control Measures Required:
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d) Work Activities
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D1. Manual Handling
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Harm - Serious back damage, sprains or torn ligaments
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Operatives to assess for the following: Load (What is it that you are going to lift), Individual (Are you up to the lift), Task (Does the task need to be done manually or can it done by other means i.e. mechanical devices?) and Environment (What are the conditions and do you have a clear route?). Where available mechanical means must be implemented. Manual handling principles must be adopted in line with manual handling training provided. Team lifts used for bulky or awkward items must use a lead person who will relay to the team the actions and routes to be taken. Ensure all routes are free from obstruction and drop location is clear.
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Residual risk - Low -
Additional Control Measures Required:
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D2. Raising materials to height using pulley system
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Harm - Serious injuries
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Materials to be raised to height using a rope pulley system. A failsafe rope is to pass through an automatic anti reverse belay pulley attached to the top of the ladder and through an automatic rope grab attached to bottom of ladder.
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Residual risk - Medium -
Additional Control Measures Required:
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D3. Cutting metal materials with hand saw
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Harm - Eye injuries due to metal fragment, cuts to hand when handling metal.
Persons at risk - Operatives
Risk rating - Medium
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Control measures to be implemented - Eye protection and gloves to be worn at all times when cutting metal using a hand saw. Hand saw must be checked by operatives before and after use. Any defects must be reported to project management immediately.
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Residual risk - Low -
Additional Control Measures Required:
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D4. Removal of waste
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Harm - Serious back damage, sprains, torn ligaments
Persons at risk - Operatives / Members of the public
Risk rating - Medium
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Control measures to be implemented - All waste that is created on site such as cardboard, cable, wood, metal brackets, bricks and electrical equipment must be taken back to Head office/depot at the end of each working day where it is must be segregated into the correct skips/bins. This will then be taken away by a licensed waste contractor
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Residual risk - Medium -
Additional Control Measures Required:
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D5. Drilling activities
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Harm - Eye Injuries due to dust particles
Persons at risk - Operatives
Risk rating - Medium
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Control measures to be implemented - Eye protection must be worn at all times when drilling to avoid eye injuries occurring
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Residual risk - Low -
Additional Control Measures Required:
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D6. Drilling in properties on high level (falling debris)
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Harm - Injuries to passing pedestrians, falling debris
Persons at risk - Operatives / Members of the public
Risk rating - High
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Control measures to be implemented - Before drilling through walls in properties 1 storey and above where there is a risk to the public from falling debris in places such as shops, public foot paths/pavements, roads, communal areas of properties such as gardens and patio areas), an area wide enough directly below on the outside must be cordoned off with cones, barrier tape and clear warning signage to prevent unauthorised access. A second man must be used to hold the net basket inside the property to catch any brick dust or falling debris. Always use a scanner before drilling into any wall.
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Residual risk - Medium -
Additional Control Measures Required:
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D7. Work Equipment
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Harm - Serious Injuries
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - When working with any work equipment, operatives must ensure the following:
• Work equipment will be maintained in efficient working order, good repair and inspected before and after use. Any defects must be reported to the Health & Safety Department immediately.
• Operatives must ensure that they are trained before using any work equipment in their correct operation.
• Operatives to ensure that they wear necessary protective clothing (such as hi viz, safety boots, gloves and where applicable, eye protection and dust masks.
• Operatives to use work equipment in the manner and for the purpose, which they were intended for use.
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Residual risk - Medium -
Additional Control Measures Required:
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D8. High risk maintenance works or complex installations
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Harm - Serious injury or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - A Permit To Work must be used in any situation where the work is of high risk to operatives. Operatives must be fully briefed of conditions set out in permit and must be signed for by an authorised person. All work areas must be segregated from members of the public by using cones, barrier tape and warning signage. At the end of works, engineers must check area to ensure that it is safe and poses no risk to members of the public. Authorised person will then check area fully and sign off permit to say works are completed.
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Residual risk - Medium -
Additional Control Measures Required:
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e) Electrical
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Are electrical works involved or connection to electrical systems?
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E1. Electric shock
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Harm - Serious Injuries, Burns or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - It is essential to carry out all necessary precautions to ensure all cables, junction boxes, sockets and fittings are not damaged in any way and are safe to use. Provide an accessible and clearly identified switch near each fixed machine to cut off power in event of an emergency. Be aware of first aid procedures in the event of an electrical shock. The use of RCD (Residual Current Device) if using equipment operating at 230 volts or higher can provide additional safety. Either, build it into main switchboard or the socket outlet as this means the supply cables are permanently protected. If this is not possible, a plug incorporating and RCD or a plug in RCD adaptor can also provide additional safety.
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Residual risk - Medium -
Additional Control Measures Required:
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E2. Alternating current electrocution
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Harm - Serious Injuries or Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Isolation procedures must be followed and electrical supplies must be locked off as necessary. An electrical permit to work must be used and any electrical circuits must be verified as "Dead".
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Residual risk - Medium -
Additional Control Measures Required:
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E3. Use of portable/transportable electrical equipment
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Harm - Serious injury, Electrocution, Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Portable Appliance Testing should be carried out by a competent person every 6 months in line with HSG INDG236 ‘Maintaining portable electric equipment in offices and other low-risk environments’. Pre use examinations should be carried out by operatives to ensure that any cables have no damage to insulation, severing to outer casing, lose connections and that fuse/pins are all in good condition.
All faults should be reported to the Health & Safety Department immediately and the equipment should not be used until it has been re tested and declared safe by a competent person.
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Residual risk - Medium -
Additional Control Measures Required:
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E4. Using electrical equipment in wet areas or conditions
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Harm - Serious injury, Electrocution, Death
Persons at risk - Operatives
Risk rating - High
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Control measures to be implemented - Ensure that equipment is suitably insulated and only tested equipment is used which has been checked by a competent person. In severe environmental conditions the use of electrical equipment must not be used and must be reported to the Health & Safety Department immediately. If working in the vicinity of the pool area, the use of a R.C.D. should be used and the use of a transformer to reduce the electrical voltage to 110V.
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Residual risk - Medium -
Additional Control Measures Required:
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E5. Overloading of power points
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Harm - Serious injury, Electrocution, Death
Persons at risk - Operatives
Risk rating - High
-
Control measures to be implemented - Operatives to ensure that enough points are available to carry out their works. One appliance should only be used at each power point to avoid the use of multipoint adaptors and the possibility of overloading. If in any doubt, contact the Health & Safety Department.
-
Residual risk - Medium -
Additional Control Measures Required:
-
E6. Trailing cables from static or portable electrical equipment
-
Harm - Serious injury, trips or burns
Persons at risk - Operatives / Members of the public
Risk rating - Medium
-
Control measures to be implemented - Cable clips must be used to tie cables together. Use hazard tape to secure cables to floor/wall etc, or the use of a cable run to prevent any slips, trips & falls. Consider installing new sockets to prevent any trailing cables and use appropriate signage to show trailing cables if you are using a portable electrical item such as a vacuum cleaner. Portable electrical equipment should be used out of hours wherever reasonably practicable.
-
Residual risk - Low -
Additional Control Measures Required:
-
E7. Faulty Cables on electrical equipment
-
Harm - Serious injuries, electric shock, Death
Persons at risk - Operatives
Risk rating - High
-
Control measures to be implemented - Visual checks of cables should be carried out by a competent person at specified times (i.e. Before use, weekly, monthly or annually depending on the type of equipment). Further advice can be obtained from the Health & Safety Department.
-
Residual risk - Medium -
Additional Control Measures Required:
-
E8. Fire caused by an electrical fault
-
Harm - Smoke inhalation, Burns, Death
Persons at risk - Operatives / Members of the public
Risk rating - High
-
Control measures to be implemented - Ensure that visual checks are carried out on a regular basis (i.e. Before use, weekly, monthly and annually). Ensure that wires are not fraying as this can cause arcing. Further advice can be obtained from the Health & Safety Department
-
Residual risk - Medium -
Additional Control Measures Required:
-
E9. Switch rooms and Fuse boards
-
Harm - Serious injuries, electric shock, Death
Persons at risk - Operatives
Risk rating - High
-
Control measures to be implemented - Ensure that distribution board circuits are correctly labelled. Keep area locked/secured at all times and ensure good housekeeping is adhered to. Must ensure that fixed installation testing is carried out by a competent person every 5 years. Further advice can be obtained from the Health & Safety Department.
-
Residual risk - Medium -
Additional Control Measures Required:
Internal work
Rack/ Head end Position
-
New head end which will be installed in a rack , which will be free standing or on a wall. Will include 1x Sky HD receiver, HDMI COFDEM modulator, Johansson profina amp, 8 way splitter, CAT 5 patch panel and audio amplifier
-
Where will the rack/ headend be located
-
Picture of new rack/ headend position
-
Is there power at the rack/ head end location, please give information on power
Screens
-
Are there any existing screens
-
How many screens are there
-
Make and size of onsite screens
-
How many of these screens have a tuner and a remote control
New screen requirements
-
How many screens to be installed
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
Screen 1
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 1
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 2
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 1
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 2
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 3
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 1
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 2
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 3
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 4
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 1
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 2
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 3
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 4
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 5
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 1
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 2
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 3
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 4
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 5
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 6
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 1
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 2
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 3
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 4
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 5
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 6
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 7
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 1
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 2
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 3
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 4
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 5
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 6
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 7
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Screen 8
-
Location of screen
-
Picture of screen in surrounding area
-
Size of the screen required in inches
-
Bracket required
-
What type mount is required
-
What fixings are required
-
If other what is required
-
RF and CAT5 cable to be installed and terminated in each location
-
Describe cable route from rack to screen
-
Any additional equipment required to run the cable
-
Picture of cable route marked up from rack to screen
Audio equipment
-
Number of speaker zones
Zone 1
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 2
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 3
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 4
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 1
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 1
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 2
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 1
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 2
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
Zone 3
-
Location of zone
-
Number of ceiling speakers in the zone
-
Number of wall speakers
-
Picture of area
General
-
Was full access available to complete survey?
-
Please give details
-
Are specific parking arrangements required?
-
Please give details
-
Is there easy access for equipment and blocks?
-
Provide details
-
Are there any special equipment/materials required?
-
Please give details
-
Estimate the number of hours/days needed to complete the installation
- 1 hour
- 2 hours
- 3 hours
- 4 hours
- 5 hours
- 6 hours
- 7 hours
- 8 hours
- ½ day
- 1 day
- 1½ days
- 2 days
- 2½ days
- 3 days
- 3½ days
- 4 days
- 4½ days
- 5 days
-
State if one, two or three man installation
-
Indicate when the installation services can be performed
- In normal office hours
- Out of hours - evenings
- Out of hours - Saturdays
- Out of hours - Sundays
-
Any additional comments?
Additional Photographs
-
Any additional photos
H&S Location Information
-
Find the nearest hospital to the site
http://www.nhs.uk/Service-Search -
Enter Phone Number and Postcode
Sign- off
Client
-
I confirm the dish/aerial/receiver location(s), internal works, cable entry route(s) and point(s) of entry are agreed
-
Client/Site Contact Name
-
Client/Site Contact Position
-
Client/Site Contact Signature
Engineer
-
Engineer Name
-
Engineer signature
