Title Page
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Job Number/Name:
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Site Address:
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Postcode:
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Surveyed by:
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Date of Survey:
PCI and General Works Area
PRE CONSTRUCTION INFORMATION (PCI)
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PCI (PRE-CONSTRUCTION INFORMATION) available and Risks have been factored in ?
BUILDING WORKS
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Insert photographs of works areas
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Will work take place on external face of building?
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Will work take place internally in the communal areas of the building?
Site Specific Design Risk Assessment
WORKING AT HEIGHTS
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A: Is there any working at heights?
Environment and Exposure
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B1: Any Risk of Asbestos exposure during the works?
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B2: Any Risk of needle injuries during Survey?
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B3: Any Risk of Environmental hazards/Bees/Wasps/Vermin and hazardous waste during Survey?
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B4: Any Risk of Un-cooperative residents or members of the public during the Survey?
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B5: Any Risk of Chemical Hazards (Hazardous substances) during the Survey?
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B6: Any Risk considerations towards Fire prevention and escape routes?
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B7: Any Risk of Potential non-ionising Radiation exposure from transmitters on roof during Survey?
Other Risks
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C: Are there any other Risks present on site that needs to be controlled?
Health and Safety Location Information
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Welfare facilities on site - Enter Details
- Welfare facilities are available on-site and permission has been granted for their use
- Suitable welfare facilities to be arranged before deployment local to the site (build time estimated greater than 1 week) i.e. welfare vehicle, agreed arrangements with local businesses
- Facilities are conveniently accessible to this worksite for short duration work (build time estimated less than 1 week) in accordance with CIS46 & CIS59
- N/A
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Is a Laydown / Storage Area required on site
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Parking on site - Enter Location Details
Sign-Off
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Surveyor Signature
