Information

  • Site

  • Postcode:

  • Job Number Reference

  • Walk Off by:

  • Date of Walk Off:

Certificate of Conformity

  • I declare that the work undertaken fully complies with the requirements of the Q-Mark Fire Stopping Installation scheme and that the work undertaken complies with Regulations 4 and 7 of the Building Regulations for England and Wales or in accordance with the local regulations in force at the specific job site location.

  • Approved Installer Name - Andy Holland

  • Approved Installer Number - 1592

Fire Stopping

  • Name of Client

  • Name of Landlord

  • Building Type

  • Number of Floors

  • Seal Category

  • Number of holes made in concrete / brick

  • Number of holes made in Fireboard / existing fire rated material

  • Product in use

  • Details

  • Product Batch Number

  • Manufacture Date

  • Expiry date

  • Provide photograph

  • Intended Fire Resistance Period if same system across installation. (If different, state hole number and Intended Fire Resistance Period)

  • Any additional items of work / product used. Provide details

  • Any existing untreated holes - provide details (location / floor )

  • Provide photographs

Photographs

  • Hole 1 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 2 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 3 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 4 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 5 - Floor / Location / Size (mm)

  • Before

  • After

  • Additional Holes

  • Hole 6 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 7 - Floor / Location / Size (mm)

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  • After

  • Hole 8 - Floor / Location / Size (mm)

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  • After

  • Hole 9 - Floor / Location / Size (mm)

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  • After

  • Hole 10 - Floor / Location / Size (mm)

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  • After

  • Additional Holes

  • Hole 11 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 12 - Floor / Location / Size (mm)

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  • After

  • Hole 13 - Floor / Location / Size (mm)

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  • After

  • Hole 14 - Floor / Location / Size (mm)

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  • After

  • Hole 15 - Floor / Location / Size (mm)

  • Before

  • After

  • Additional Holes

  • Hole 16 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 17 - Floor / Location / Size (mm)

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  • After

  • Hole 18 - Floor / Location / Size (mm)

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  • After

  • Hole 19 - Floor / Location / Size (mm)

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  • After

  • Hole 20 - Floor / Location / Size (mm)

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  • After

  • Additional Holes

  • Hole 21 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 22 - Floor / Location / Size (mm)

  • Before

  • After

  • Hole 23 - Floor / Location / Size (mm)

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  • After

  • Hole 24 - Floor / Location / Size (mm)

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  • After

  • Hole 25 - Floor / Location / Size (mm)

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  • After

  • Hole 26 - Floor / Location / Size (mm)

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  • After

  • Hole 27 - Floor / Location / Size (mm)

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  • After

  • Hole 28 - Floor / Location / Size (mm)

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  • After

  • Hole 29 - Floor / Location / Size (mm)

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  • Hole 30 - Floor / Location / Size (mm)

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  • After

  • Hole 31 - Floor / Location / Size (mm)

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  • After

  • Hole 32 - Floor / Location / Size (mm)

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  • After

  • Hole 33 - Floor / Location / Size (mm)

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  • After

  • Hole 34 - Floor / Location / Size (mm)

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  • After

  • Hole 35 - Floor / Location / Size (mm)

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  • After

  • Hole 36 - Floor / Location / Size (mm)

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  • Hole 37 - Floor / Location / Size (mm)

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  • Hole 38 - Floor / Location / Size (mm)

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  • After

  • Hole 39 - Floor / Location / Size (mm)

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  • After

  • Hole 40 - Floor / Location / Size (mm)

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  • After

  • Additional Holes

  • Hole 41 - Floor / Location / Size (mm)

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  • After

  • Hole 42 - Floor / Location / Size (mm)

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  • After

  • Hole 43 - Floor / Location / Size (mm)

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  • After

  • Hole 44 - Floor / Location / Size (mm)

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  • After

  • Hole 45 - Floor / Location / Size (mm)

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  • After

  • Hole 46 - Floor / Location / Size (mm)

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  • After

  • Hole 47 - Floor / Location / Size (mm)

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  • After

  • Hole 48 - Floor / Location / Size (mm)

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  • After

  • Hole 49 - Floor / Location / Size (mm)

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  • After

  • Hole 50 - Floor / Location / Size (mm)

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  • After

  • Hole 51 - Floor / Location / Size (mm)

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  • After

  • Hole 52 - Floor / Location / Size (mm)

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  • After

  • Hole 53 - Floor / Location / Size (mm)

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  • After

  • Hole 54 - Floor / Location / Size (mm)

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  • After

  • Hole 55 - Floor / Location / Size (mm)

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  • After

  • Hole 56 - Floor / Location / Size (mm)

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  • After

  • Hole 57 - Floor / Location / Size (mm)

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  • Hole 58 - Floor / Location / Size (mm)

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  • After

  • Hole 59 - Floor / Location / Size (mm)

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  • After

  • Hole 60 - Floor / Location / Size (mm)

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  • After

  • Additional Holes

  • Hole 61 - Floor / Location / Size (mm)

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  • After

  • Hole 62 - Floor / Location / Size (mm)

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  • After

  • Hole 63 - Floor / Location / Size (mm)

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  • Hole 64 - Floor / Location / Size (mm)

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  • After

  • Hole 65 - Floor / Location / Size (mm)

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  • After

  • Hole 66 - Floor / Location / Size (mm)

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  • After

  • Hole 67 - Floor / Location / Size (mm)

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  • After

  • Hole 68 - Floor / Location / Size (mm)

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  • After

  • Hole 69 - Floor / Location / Size (mm)

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  • After

  • Hole 70 - Floor / Location / Size (mm)

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  • Hole 71 - Floor / Location / Size (mm)

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  • Hole 72 - Floor / Location / Size (mm)

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  • Hole 73 - Floor / Location / Size (mm)

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  • Hole 74 - Floor / Location / Size (mm)

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  • Hole 75 - Floor / Location / Size (mm)

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  • After

  • Hole 76 - Floor / Location / Size (mm)

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  • Hole 77 - Floor / Location / Size (mm)

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  • After

  • Hole 78 - Floor / Location / Size (mm)

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  • Hole 79 - Floor / Location / Size (mm)

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  • After

  • Hole 80 - Floor / Location / Size (mm)

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  • After

Sign Off

Sign Off

  • Additional Notes / Information

  • Contractor Name

  • Contractor Address

  • Contractor Contact Details

  • Operative

  • Supervisor

  • Completed Sign Off

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