• PLEASE EMAIL THIS FORM INTO HEAD OFFICE ONCE COMPLETED:

    claire.kilby@corsan.co.uk & caroline.burns@corsan.co.uk

  • BEFORE WORKS ARE STARTED A RISK ASSESSMENT MUST BE COMPLETED.

    PLEASE USE THE iAUDITOR SOFTWARE.

INSTALLATION DETAILS

  • Date:

  • Day:

  • Clients Name:

  • Contact Number:

  • Email Address (If Available):

  • Installation Address:

HEALTH & SAFETY

  • PLEASE SELECT FROM THE LIST BELOW THE RISKS THAT MAYBE ASSOCIATED WITH THE WORK TO BE CARRIED OUT.

    IF A RISK IS IDENTIFIED A DESCRIPTION OF HOW TO REDUCE OR REMOVE THE RISK IS TO BE SUGGESTED AND CARRIED OUT PRIOR TO WORKS COMMENCING.

    WHERE PRACTICABLY POSSIBLE FULL PPE MUST BE WORN AT ALL TIMES THIS INCLUDES:

    1. HARD HAT
    2. BOOTS
    3. PROTECTIVE GLOVES
    4. EYE PROTECTION
    5. HI VISIBILITY VEST
    6. EAR PROTECTION
    7. FACE FIT MASK

    IT IS YOUR RESPONSIBILITY TO WORK SAFELY, PROTECTING YOURSELF, WORK COLLEAGUES, GENERAL PUBLIC, PROPERTY AND LIVE STOCK.

  • RA001 - Working Around Public

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • RA002 - Lone Working

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • RA003 - Working With Electricity

  • WARNING - LOCKING OFF MUST BE IMPLEMENTED IN ALL CASES WHEN WORKING WITH ELECTRICITY.

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • RA004 - Ladders

  • WARNING - CERTAIN SITES DO NOT PERMIT THE USE OF LADDERS OR STEP LADDERS.

    IF THIS IS THE CASE THEN HOP-UPS OR TOWER SCAFFOLDING MUST BE USED.

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • RA005 - Hand Tools

  • WARNING - THE USE OF STANLEY KNIVES ARE BANNED FROM CERTAIN SITE, PLEASE CONFIRM THEY ARE PERMITTED BEFORE USING.

    THE CORRECT CATEGORY OF GLOVES MUST BE WORN AT ALL TIMES (C5).

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • RA006 - Power Tools

  • WARNING - PLEASE ENSURE ALL POWER TOOLS ARE 110v AND FIT FOR PURPOSE.

    ALL PORTABLE APPLIANCES MUST BE PAT TESTED AND WITHIN DATE (12 MONTHS MINIMUM).

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • RA007 - Slips, Trips & Falls

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • RA008 - Confined Spaces

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • RA009 - Working at Height

  • Describe the Risk Identified:

  • Give Details of How to Reduce or Remove the Risk:

  • If the Above Restrictions are in place Is it Safe to Proceed?

  • WARNING - WORKING ON LIVE CIRCUITS IS NOT PERMITTED.

    CIRCUITS SHOULD BE CORRECTLY IDENTIFIED, ISOLATED AND LOCKED OFF BEFORE ANY WORKS COMMENCE.

INSTALLATION DETAILS

  • Start Time:

  • Finish Time:

  • Total Hours (Including Travel):

  • Materials / Stock:

  • Materials Used:

  • Equipment
  • Quantity & Description:

  • Details of Works Carried Out:

  • Provide Photographic Evidence of the Works Completed:

ENGINEER SIGN OFF

  • Confirm that all Works Carried Out are Compliant with Current Regulations.

  • All works Completed by Corsan are Protected by RCD?

  • Main Gas and Water Bonds are Present and are a Minimum of 6.0mm?

  • Has the Installation been Tested with the Appropriate Certificate Issued to Head Office?

  • Does the Work need Notifying to Building Control (Part P)?

  • PLEASE INFORM THE OFFICE OF THE NOTIFICATION ENSURING THE CORRECT DETAILS ARE SUPPLIED.

    NOTIFICATION IS COMPLETED BY THE ADMINISTRATION TEAM VIA THE NICEIC WEBSITE.

  • Are all Works Completed? (If NO - Please insert what is required to Complete).

  • Can the Completed Work be Invoiced?

  • Print & Sign:

CUSTOMER SATISFACTION

  • WE WOULD APPRECIATE YOUR TIME TO COMPLETE OUR CUSTOMER SATISFACTION SECTION:

    10 = EXCELLENT
    5 = AVERAGE
    1 = POOR

  • 1.0 Was the Engineer Polite and Approachable.

  • 2.0 Was the Engineer On Time?

  • 3.0 Are you Satisfied with the Quality of the Installation?

  • 4.0 How would you Rate our Service Overall?

  • 5.0 Would you use Corsan again? (If 'NO' please explain what we could improve on).

  • Would you be willing to leave us feedback on your overall experience (This may be used as part of our Website).

CLIENT SIGN OFF

  • PLEASE TAKE NOTE OF THE TIME TAKEN TO COMPLETE THE WORKS (THIS INCLUDES TRAVEL AND IS NOTED ABOVE - IF IN DOUBT ASK THE ENGINEER FOR ASSISTANCE), A RATE OF £30.00 p/h WILL BE CHARGED UNLESS A FIXED PRICE HAS ALREADY BEEN AGREED.

    OUR PAYMENT TERMS ARE STRICTLY 14 DAYS DATE OF INVOICE.

    BY SIGNING THIS FORM YOU ARE CONFIRMING THAT YOU ARE SATISFIED WITH THE WORKS COMPLETED AND AGREE TO BE INVOICED.

  • Print & Sign:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.