Title Page
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Conducted on
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Prepared By
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Location
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Please take a photograph of the front elevation
Please Complete All Fields
PRE-INSPECTION
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Has the property been fully inspected internally & externally for damage prior to commencing work?
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Have cavity heads been checked and appropriately sealed prior to carrying out the installation process to prevent material & dust ingress?
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Have all rooms been checked for possible ingress points such as gaps in window seals, kitchen pipes, bathroom pipes, over-flow pipes & un-sleeved internal vents?
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Have the ventilation requirements and Flue/Chimney location been identified?
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Have all rooms been checked for fuel burning appliances & spillage test carried out where necessary? - Lead Technician to complete Flue Certificate and locate in Loft
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Have all rooms been checked for ornaments and pictures on the inside of external walls & window sills?
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Have all rooms been checked for recesses and single-skin walls?
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Has meter box been checked and sealed accordingly?
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Is a cavity barrier required for adjoining/neighbouring properties?
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Has a Take-5 Dynamic Risk Assessment been completed?
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Has a 2m clearnace been created externally around the property (garden furniture, plants, sheds etc.)
BEAD FLOW RATE CHECKS
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Pipe 1
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Pipe 2
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Batch Number of Product
Glue Flow Rate Checks
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Jet Sizes used
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Glue Flow Rate
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Batch Number
Post inspection and completion Declaration
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Has 50% of the drilling been shared and is the drilling pattern to specification?
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Where rooms have fuel burning appliances, has a spillage test been carried out? Lead Technician to complete Flue Certificate and locate in Loft
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Has the Roof-Space been inspected for material ingress?
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Have all rooms been inspected for material ingress?
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Has ventilation been maintained and safeguarded?
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Have Cavity Barriers been used?
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Have all drill holes been filled, colour & texture matched?
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Has meter box been inspected for material and dust ingress?
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Has the property been inspected for damage?
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Has a Thermascopic Lance been used?
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Have all areas been fully cleaned, swept & hosed down? (Check gutters, pathways, driveways, all window sills, public road, garden and neighbours property)
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Has the handover pack been provided to the client and are they are aware of the requirements needed to maintain the Cavity Wall System? (if applicable)
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Notes:
TECHNICIAN 1 SIGNATURE (a1)
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PRINT NAME (a1)
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Signature
TECHNICIAN 2 SIGNATURE (a2)
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PRINT NAME (a2)
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Signature
PRINT NAME (a2)
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I, the undersigned, have been explained the above checks and have been shown around the property, making-good and housekeeping
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CLIENT NAME
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CLIENT SIGNATURE
Flue Certificate
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Please ensure a 2 photographs of the completed flue certificate is attached to this document, 1 full size readable and one positioned in the loft space.
Site Specific Risk Assessment
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Identify hazards that are associated with work undertaken
- Drilling
- Cutting / Drilling
- Dust
- Lifting / Carrying
- Hazardous Waste
- Hazardous Substances / COSH
- Hot Works
- Cellar Access
- Floor Access
- Loft Access
- Boiler into Loft
- Tenants
- Use of Ladder
- Loose of Step Ladder
- Loose Carpet
- Asbestos
- Access / Egress
- Children / Elderly
- Roof Works
- Confrontation
- Unsafe Structure
- Poor Hygiene
- Weather
- Public Passerby
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Controls to control selected hazards
- Ear Muffs / Plugs
- Face Mask (P3)
- Gloves
- Safety Footwear
- Harness / Lanyard
- Lifting Straps
- Check Power Tools
- Refer to COSSH Assessment
- Eye Protection
- Safety Helmet
- Anti Slip Ladder
- Ladder Stand Off
- Remove Hazards
- Loft Boarding
- RCD
- Hazard Warning Signs
- A Frames
- Barrier Tape
- Rigid Barriers
- Sack Barrows
- Tidy / Clean Work Places
- Lighting Unit
- Hi Visibility Clothing
- Vacuum
- Fire Checks
- Cool Gels
- Hot Mats
- 2 Person Lifts
- Fire Marshall Assistance
- Fire Extinguisher
- Inform Tenants of Prohibited Access
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Additional Controls Carried out
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If contract manager assistance is required, has this been planned?
- Yes
- No
- N/A
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Contact Electrician to Arrange Wiring up of a System?
- Yes
- No
- N/A
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Print Name
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Signature
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Date