Title Page

  • Conducted on

  • Prepared By

  • Location
  • Please take a photograph of the front elevation

Please Complete All Fields

PRE-INSPECTION

  • Has the property been fully inspected internally & externally for damage prior to commencing work?

  • Have cavity heads been checked and appropriately sealed prior to carrying out the installation process to prevent material & dust ingress?

  • 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?

  • Have the ventilation requirements and Flue/Chimney location been identified?

  • 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

  • Have all rooms been checked for ornaments and pictures on the inside of external walls & window sills?

  • Have all rooms been checked for recesses and single-skin walls?

  • Has meter box been checked and sealed accordingly?

  • Is a cavity barrier required for adjoining/neighbouring properties?

  • Has a Take-5 Dynamic Risk Assessment been completed?

  • Has a 2m clearnace been created externally around the property (garden furniture, plants, sheds etc.)

BEAD FLOW RATE CHECKS

  • Pipe 1

  • Pipe 2

  • Batch Number of Product

Glue Flow Rate Checks

  • Jet Sizes used

  • Glue Flow Rate

  • Batch Number

Post inspection and completion Declaration

  • Has 50% of the drilling been shared and is the drilling pattern to specification?

  • Where rooms have fuel burning appliances, has a spillage test been carried out? Lead Technician to complete Flue Certificate and locate in Loft

  • Has the Roof-Space been inspected for material ingress?

  • Have all rooms been inspected for material ingress?

  • Has ventilation been maintained and safeguarded?

  • Have Cavity Barriers been used?

  • Have all drill holes been filled, colour & texture matched?

  • Has meter box been inspected for material and dust ingress?

  • Has the property been inspected for damage?

  • Has a Thermascopic Lance been used?

  • Have all areas been fully cleaned, swept & hosed down? (Check gutters, pathways, driveways, all window sills, public road, garden and neighbours property)

  • 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)

  • Notes:

TECHNICIAN 1 SIGNATURE (a1)

  • PRINT NAME (a1)

  • Signature

TECHNICIAN 2 SIGNATURE (a2)

  • PRINT NAME (a2)

  • Signature

PRINT NAME (a2)

  • I, the undersigned, have been explained the above checks and have been shown around the property, making-good and housekeeping

  • CLIENT NAME

  • CLIENT SIGNATURE

Flue Certificate

  • 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

  • Identify hazards that are associated with work undertaken

  • Controls to control selected hazards

  • Additional Controls Carried out

  • If contract manager assistance is required, has this been planned?

  • Contact Electrician to Arrange Wiring up of a System?

  • Print Name

  • Signature

  • Date

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. You should independently determine whether the template is suitable for your circumstances.