BOA Risk Proforma

• B.O.S Ref No

• Surveyors Name

• Surveyor contact number

• Location
  Address

• Conducted on

  Date

• Is there a vulnerable customer at the address?

  Yes

  No

• Any special access instructions if so please provide details

• Meter location

• Has the building been modified or extended since construction to create the built over service or is it as built

  as built

  had extension

• How many primary meters are there in the building?

• Diameter

• Service material (if service head adaptor visible class as pe)

  P.E

  Steel

  Copper

  Lead

Assessment Checklist

• Does the built over pipe operate at a pressure greater than 75mbar

  Yes

  No

• Is the pipe diameter greater than 32mm?

  Yes

  No

• Has the pipe got a steel tail with any of the exposed steel pipe going in to the ground

  Yes

  No

• Does any of the above ground service pipe run in an unventilated void

  Yes

  No

• Is any of the above ground service pipe unsleeved should it pass through a cavity wall

  Yes

  No

• Has any of the exposed service pipe or sleeving been damaged?

  Yes

  No

• Have the building works created a contravention of the gas safety (installation and Use) Regulations with regard to the position and operation of the ECV or access to the meter

  Yes

  No

• If the answers to any of the above are yes then class as high risk. If all answers are no then class as low risk

  high risk

  low risk

• Photos

  Media

• Comments

• Has any other significant risks been identified on site

  Yes

  No

• If yes please describe

• Site contact details: name

• Telephone number

• Mobile number

• Additional information

Site survey form

• Work instruction notes

• Easement, way leave, consent required?

  Yes

  No

• Footway closure required?

  Yes

  No

• Parking suspension(s) required?

  Yes

  No

• Opening Notice required

  Yes

  No

• 1. None/signing only

  Yes

  No

• 2. Traffic control (stop/ go boards)

  Yes

  No

• 3. Traffic control (two way signals)

  Yes

  No

• 4. Traffic control (multi way signals)

  Yes

  No

• 5. Traffic control (give and take)

  Yes

  No

  N/A

• 6. Traffic control (Priority working)

  Yes

  No

• 7. Traffic control (convoy working)

  Yes

  No

• 8. Lane closure

  Yes

  No

• 9. Contra-flow

  Yes

  No

• 10. Road closure

  Yes

  No

• Mains pressure

  Low

  Medium

  Intermediate

• Name of representative on site

• Works duration (hours)

• Agreed plan date (if applicable)

  Date

• Engineering comments

• Premise address

• Public length (m)

• Quantity

• Surface public

  Select Flags Fbm Dbm Sma Hra Sandcarpet Concrete Block paving Grass verge Unmade Setts

  • Flags
  • Fbm
  • Dbm
  • Sma
  • Hra
  • Sandcarpet
  • Concrete
  • Block paving
  • Grass verge
  • Unmade
  • Setts

• Surface private

  Yes

  No

  N/A

• Cutback (m)

• Reconnect

  Yes

  No

• Relay required

  Yes

  No

• Amount of pipe required for outlet pipe work (m)

• Diameter and material of pipe required