CDM 2015 - Pre Construction Information

• Surveyor

• Surveyor Email:

• Surveyor Phone number:

• Risk Address
  Address

• Peril

  Select Escape of water Fire Flood Impact Storm Accidental Damage Other

  • Escape of water
  • Fire
  • Flood
  • Impact
  • Storm
  • Accidental Damage
  • Other

• Severity

  Light

  Medium

  Heavy

• Parking Restrictions?

  Yes

  No

• Date of Visit

  Date

• Reference

• Adjuster Reference

• Customer Name

• Who is the Principal Desinger

  Sedgwick Building Consultants

  Repair Solutions

  Contractor

• Who is the CDM client?

• Are there any other designers involved in the project (if Y insert details)

  Yes

  No

• Have you confirmed the identify of the person you are meeting?

  Yes

  No

  N/A

• Have you agreed a check in procedure with the Hub or your Regional Manager (required on all projects with a remote location, lone working, hazardous weather or a challenging customer.

  Yes

  No

  N/A

• Can working at height be avoided during your survey?

  Yes

  No

• I have the relevant PPE on to complete the survey.

  Yes

  No

• If the property is constructed before the year 2000 do you have concerns that possible ACM's have been disturbed?

  Yes

  No

  Post 2000 property

• Are any of the following hazards present to you during your survey?

  Select Agressive/abusive customer? Dog/other animal on site? live electrical cables solar panels not made safe Flammable gas/fumes unstable building open floors slippery surfaces sewage/black water mould/dust drug needles low ceilings/door openings working at height low light lone working aggressive animals unsafe electrics high levels of mould loose parts of the structure no further hazards noted

  • Agressive/abusive customer?
  • Dog/other animal on site?
  • live electrical cables
  • solar panels not made safe
  • Flammable gas/fumes
  • unstable building
  • open floors
  • slippery surfaces
  • sewage/black water
  • mould/dust
  • drug needles
  • low ceilings/door openings
  • working at height
  • low light
  • lone working
  • aggressive animals
  • unsafe electrics
  • high levels of mould
  • loose parts of the structure
  • no further hazards noted

• Have you identified any other hazards/risks on the site

  Yes

  No

• This checklist should be used to assist the Client, Principal Designer, designers, Principal Contractor and contractors to think about and identify any relevant health and safety information for the project. The prompts on this checklist are not exhaustive and there may be other project specific hazards that need to be identified and risks considered. Any relevant information about the existing premises, design etc should be added to the relevant sections of the ‘Client Brief and Health & Safety Information’ document (and/or on construction drawings, or separate documents where appropriate to convey the information directly, simply and clearly). The amount of information will be commensurate with the complexity and scope of hazards/risks on a project (e.g. small projects will usually only have a small number of key hazards/risks).

• Will the property be empty and secured from unauthorised access during the repairs

  Yes

  No

• Is the property free from existing on site activities which the contractor should be aware of?

  Yes

  No

• Is the property located in an area which will avoid the need for traffic management/controlled delivery times due to volume of traffic, schools etc?

  Yes

  No

• Can the works be undertaken without the need to control noise?

  Yes

  No

• Is there an existing H&S file for the property?

  Yes

  No

• Is there an existing site drawings for the property?

  Yes

  No

• Is the property structurally stable?

  Yes

  No

• Are the full extent of the works evident?

  Yes

  No

• Has all services been identified?

  Yes

  No

• Is the site and adjacent sites/properties free from hazardous materials or equipment such as (but not limited to) overhead power, substations, railways, rivers, footpaths, differences in height

  Yes

  No

• can access to the site be gained without affecting any weight restrictions, over bridges for example?

  Yes

  No

• Can materials be delivered and stored in a normal manner without special arrangements?

  Yes

  No

• can the works be completed without working at height?

  Yes

  No

• Can the property be left in its current condition without temporary works being required?

  Yes

  No

• Are there existing facilities on site which can be used by the contractor for welfare?

  Yes

  No

• Are there any areas of the site which are "no go" areas for the contractor? (if Y provide details)

  Yes

  No

• Can the works be completed without any "permit to work" systems?

  Yes

  No

• Can the works be completed without materials which require particular caution?

  Yes

  No

• Please record any risks below which have not been identified above.

• Date of Instruction

  Date

• Send completed form to info@sci-group.co.uk and copy in OSHFNOL@uk.sedgwick.com and sergonasbestos@uk.sedgwick.com

Access Arrangements

• Property Occupied

  Yes

  No

• Contact name for access:

• Status of contact:

  Select Insured Spruce/partner Relation Tenant Friend Neighbour Contractor Other

  • Insured
  • Spruce/partner
  • Relation
  • Tenant
  • Friend
  • Neighbour
  • Contractor
  • Other

• Contact Phone Number

• Alternative details

• Comments

• Key Safe available?

  Yes

  No

• Code:

• Location:

• Surveyor to consider whether contents removal/ removal of fixtures is to be organized to allow SCI to complete testing and any subsequent asbestos removal. SCI can quote for temporary removal of contents and/or demonizing of fixtures if required. Add additional comments if necessary:

Health & Safety

• Parking Restrictions

  Yes

  No

• Working at Height

  Yes

  No

• Windows Boarded

  Yes

  No

• Open Floors

  Yes

  No

• Vulnerable Occupants

  Yes

  No

• Power on Site

  Yes

  No

• Areas of Instability

  Yes

  No

• Debris

  Yes

  No

• Comments/Other

Floor Levels to be affected by building works

• Level

  Select External Basement Ground First Second Loft/Attic Garage All Areas Other areas

  • External
  • Basement
  • Ground
  • First
  • Second
  • Loft/Attic
  • Garage
  • All Areas
  • Other areas

• Comments

Areas of Property affected by Building work

• Area/Room

• Floor Level

  Select External Basement Ground First Second Loft/Attic Garage All Areas Other areas

  • External
  • Basement
  • Ground
  • First
  • Second
  • Loft/Attic
  • Garage
  • All Areas
  • Other areas

• Areas for inspection

  Select Ceiling Wall Floor Fireplace Surround Boxing Panels Window Surround Roof Void Floor Void Soffits & Fascia Roof

  • Ceiling
  • Wall
  • Floor
  • Fireplace Surround
  • Boxing Panels
  • Window Surround
  • Roof Void
  • Floor Void
  • Soffits & Fascia
  • Roof

• Specific Exclusions

FASCIAS/SOFFITS/ROOF WORK

• Presume Positive (Do not test)

  Yes

  No

  N/A

• Suitable Access on site (Confirm access)

• SCI to Quote for Access

  Yes

  No

  N/A

• Additional Comments