Information

  • Site conducted

  • Measure carried out?

  • Clients Name

  • Postcode

  • Clients Address
  • Installation Date

  • Crew

  • Crew Leader Full Name

Health And Safety

  • Is all Electrical Equipment, Access Equipment, PPE and H&S Equipment up to Standard and Suitable for Use?

  • REPORT DEFECT TO YOUR LINE MANAGER

  • What equipment is faulty, and discription of fault?

  • Equipment ID

  • Photo of equipment showing fault

  • Who have you reported the issue too?

  • Name of person reported too?

Site Details

  • Photo of Front of Property:

  • 1. What is the dwelling type?

  • 2. Number of bedrooms?

  • 3. Main Heating Type

  • 4. Secondary Heating Type

  • 5. Access equipment required:

  • Type Of Access equipment

  • 6. Measures installed:

CAVITY WALL INSULATION

Inspection Details

  • 7. Was the measure installed as part of new dwelling/extension?

  • 8. Was 100% of property installed?

  • Percentage of property installed

  • Reason for not installing 100%

  • Photos

  • Sqm not installed

  • 9. Insulation Used?

  • Confirm elevations installed

  • PRE-WORKS PHOTOS

  • Photo of Front Elevation pre-works

  • MID WORKS PHOTOS

  • Photo of Elevation drilled.

  • Photo of Injection Gun in Wall

  • Photo of Left elevation pre-works

  • MID WORKS PHOTOS

  • Photo of Elevation drilled.

  • Photo of Injection Gun in Wall

  • Photo of Right elevation pre-works

  • MID WORKS PHOTOS

  • Photo of Elevation drilled.

  • Photo of Injection Gun in Wall

  • Photo of Rear elevation pre-works

  • MID WORKS PHOTOS

  • Photo of Elevation drilled.

  • Photo of Injection Gun in Wall

  • Photo of Extension Pre-Works

  • MID WORKS PHOTOS

  • Photo of Elevation drilled.

  • Photo of Injection Gun in Wall

  • 10. Is the material appropriate for the exposure zone?

  • 11. Is the work guaranteed by a CIGA warranty?

  • 12. If not, has another guarantee been issued for 25 years?

  • 13. Total meterage Installed (m2)

  • 14. Does the drilling pattern ensure an even distribution of material?

  • Photo of empty injection hole

  • Photo of bead in Injection hole

  • 15. Are cavity brushes been fitted?

  • Photos showing Brush being fitted/ or neighbours property insulated

  • 16. Have all injection hole been made good?

  • 17. Does colour match existing finish?

  • Photo of each Elevation Installed Post-works

  • Close up Photo of each elevation showing Drill Pattern

  • 18. Are all air vents/bricks clear of insulation, sleeved or sealed.

  • Photo Showing Clear Airbricks

  • 19. Are combustion vents/flues/chimneys clear of insulation and in compliance with HSE/CIGA guidance?

  • Photo of Clear Vents

  • 20. Has a smoke spillage test been carried out?

  • 21. Was a combustion vent fitted?

  • Photo of Combustion Vent.

  • 22. Has meter boxes been checked and brushed if necessary?

  • Photo inside meterbox showing clear of insulation

  • 23. Are the eaves vents clear of insulation?

  • Photo Of Clear Eaves/ Loft Space

  • 24. Has a flue cert been completed and stapled in the loft?

  • Photo of Flue Cert.

  • 25. Is there a risk to health & safety, or the environment?

LOFT INSULATION

Inspection Details

  • 7. Was the measure installed as part of new dwelling/extension?

  • 8. Was 100% of property installed?

  • Percentage Of Property installed

  • Reason for not installing 100%

  • Sqm of area not installed

  • SQM Installed

  • SQM Installed

  • 9. Type of insulation used

  • 10. Is the type of insulation installed as specified in the project plan?

  • 11.Thickness of Original material (mm)

  • Photos Pre-Works all areas.

  • 12.Thickness of material added (mm)

  • Photo Mid-Works all areas

  • 13. Total Thickness of material (mm)

  • Photo Post-Works all areas

  • 14. Is the thickness of insulation installed as specified in the project plan?

  • Photo with Tape Measure showing post works depth.

  • 15. Has the insulation been close butted?

  • 16. Has the insulation been cross laid to prevent cold bridging?

  • 17. Has the loft hatch been properly insulated as specified in PAS 2030:2012?

  • Photo of loft Hatch insulated.

  • Photo of Loft Hatch

  • 18. Has the hatch been properly draught proofed as specified in PAS 2030:2012?

  • Photo of Hatch/Draught Proofing

  • Reason Loft Hatch not Draught Proofed?

  • 19. Is the area around down-lights kept clear of insulation?

  • 20. Do the down-lights have the "F-capped" symbol, or have caps been fitted?

  • Photos of Downlights and covers

  • 21. Has walkway been fitted for any live tanks 0.5m from Hatch?

  • Photos of access walkway

  • 22. Has Pipes and Tanks been insulated?

  • Photos of Pipes and Tanks

  • 23. Ventilation safeguarded and eaves clear?

  • Photos of ventilation safeguarded and clear eaves. (ALL AREAS OF LOFT)

  • Reason for not safe guarding Ventilation?

  • Photos

  • 24. Power Cables above Insulation?

  • Photo of cables above insulation.

  • 25. Has Danger Sign been stapled in loft space?

  • Photo Of Danger notice stapled in Loft

  • Reason for not fitting Warning notices?

  • Photos

  • 26. Loft Cert stapled in Loft?

  • Photo Of Loft Cert Stapled in Loft

  • Reason for not Stapling in Loft?

  • Photo of Loft cert

  • 27. Has additional ventilation been installed?

  • Photos of additional ventilation.

  • 28. Has storage area been maintained?

  • Photos of Storage area.

  • 29. Is there a risk to health & safety, or the environment?

CANCELLATION REPORT

  • Measure to be Installed

  • Reason For Cancellation

  • Describe reasons for Cancellation

  • Photos Showing Issue

  • Who was Cancellation reported too?

  • Name of person reported too?

EXTRACTION WORKS

  • PRE-WORK CHECKS

  • 7. Select Elevations to be Extracted

  • Photo of Front Elevation before works commence

  • Photo of Right Elevation before works commence

  • Photo of Left Elevation before works commence

  • Photo of Rear Elevation before works commence

  • Photo of Extension before works commence

  • 8. Has client been advised of method of works?

  • 9. Is there evidence or is the client aware of any electrical cables within the cavity?

  • 10. Is the client aware of any potential material ingress?

  • 11. Items removed from window sills?

  • 12. Are all vehicles and movable items removed from work areas?

  • 13. Are all air ventilators closed/ temporary sealed to prevent ingress?

  • 14. Cavity heads closed/ sealed within loft space to prevent ingress?

  • 15. Note position of DPC's and cavity trays to prevent drilling into them

  • 16. Any Pre-works issues/ property damage noted?

  • Detail issues noted

  • Photos of any issues/ existing property damage

  • POST-WORKS CHECKS

  • 17. Confirm material Extracted

  • Material Extracted

  • 18. Confirm Elevations Extracted

  • Photo of Front Elevation Post Works

  • Photo of Clear Cavity Post Works (3 Borescope Photos Min)

  • Photo of Right Elevation Post Works

  • Photo of Clear Cavity Post Works (3 Borescope photos min)

  • Photo of Left Elevation Post Works

  • Photo of Clear Cavity Post Works (3 Borescope photos min)

  • Photo of Rear Elevation Post Works

  • Photo of Clear Cavity Post Works (3 Borescope photos min)

  • Photo of Extension Post Woks

  • Photo of Clear Cavity Post Works (3 Borescope photos min)

  • 19. Suspended/ Timber floor air ventilators clear/ unobstructed?

  • 20. Kitchen, Bathroom, Room ventilators clear/ unobstructed?

  • 21. Loft ventilation clear/ unobstructed

  • 22. Making good of all drilling/ extraction points complete and satisfactory?

  • Photos of all extraction points after work is completed and re-pointed.

  • 23. Meter box checked post works?

  • Photo of clear meter box.

  • Photo of Meter box

  • Reason for not checking meter box?

  • 24. All windows, doors, drive and pathways cleaned down fully?

  • Photos of clean up (Path and Driveways, Doors and Windows etc)

  • 25. All debris and waste material removed from site for disposal?

  • Reason for not removing debris and waste

PARTY WALL INSULATION

  • Party Wall Insulation

  • Do Both Parties agree to works?

  • Address of adjoining property
  • Photo of adjoining Property

  • Step 1: Internally measure from internal party wall to window/door reveal on both properties (A + B)
    Step 2: Externally measure from window/door wall edge to window/door wall edge on both properties measurement (C) minus A + B = measurement (D)
    Step 3: Deduct Plaster (12mm) or Plaster & Batten (37mm) and finally Brick/Block (100mm) from measurement (D) = Cavity width (E)
    Step 4: Chalk mark the cavity width on wall this will identify the centre of the cavity ready for cavity inspection.

    Party Wall.jpg
  • 7. Insulation Used?

  • Photo of Front Elevation

  • Photo of Front Party line

  • Photo of Rear Elevation

  • Photo of Rear Party line

  • 8. Total Sqm Installed

  • 9. Does the drilling pattern ensure an even distribution of material?

  • Photo of empty injection hole

  • Photo of Injection gun in wall

  • Photo of insulation in Injection hole

  • 10. Does Party wall have a chimney?

  • Photo of chimney/ Fireplace

  • Has a smoke test been completed?

  • 11. Is a combustion vent required?

  • Fitted on install?

  • Photo of Combustion Vent

  • Reason combustion vent not Fitted?

  • Details vent not fitted

  • Photo evidence

  • 12. Have all injection hole been made good?

  • 13. Does colour match existing finish?

  • Photo of each Elevation Installed Post-works

  • 14. Are the eaves vents clear of insulation?

  • Photo Of Clear Eaves/ Loft Space

  • 15. Has a flue cert been completed and stapled in the loft?

  • Photo of Flue Cert stapled in the loft.

  • 16. Clean up in all working areas satisfactory?

  • Photos of path and Driveways

  • 17. Is there a risk to health & safety, or the environment?

  • 7. Was the measure installed as part of new dwelling/extension?

  • 8. Was 100% of property installed?

  • Percentage of property not installed

  • Reason for not installing 100%

  • Sqm not installed

  • 9. Photos of Sub-floor Area (Whole Underfloor area)

  • 10. Have all Gaps in the floor been sealed around services.

  • Photos of Gaps

  • 11.Depth of Joists

  • Photo of Joist Depth with measuring tape

  • 12.Measurement of gap from joist bottom to ground level in several areas

  • 13.Photographs to show floorboards in good condition and firmly fixed, without any significant cracks, splits and missing fixings

  • 14. The structure of the existing floor is suitable for the insulation i.e. no evidence of damp, rot etc.

  • Photos of Structure

  • 15. Photos showing that 100% of area has been installed

  • 16. Photos Showing that insulation is not sagging and is sealed at edges

  • 17. Photo of insulation thickness installed

  • 18. Evidence showing any service penetrations through the floor are sealed

  • 19. Water pipework in the newly formed "cold space" is insulate

  • Photos of Insulated Pipework

  • 20. Photos showing the insulation does not bridge the DPC

  • 21. Any combustion appliances in the space to be insulated have appropriate combustion ventilation

  • 22. Any high amperage cables (electric shower/cooker etc) that may be clipped to the underside of the floor joist are not covered by insulation

  • 23.Any recessed floor lighting is safeguarded

  • Photos of safe guarded floor lighting

  • 24.Any other in-situ equipment has not been compromised by the work undertaken

  • Comments:

  • Additional Photos:

  • Inspectors name/signature:

  • Customers name/signature:

  • Remote TM Inspection Report and Evidence

  • Select Measure

  • CAVITY TM QUESTIONS

  • TMQ1: Have all avoidable thermal bridges/heat loss areas which could have been insulated, been insulated ?

  • TMQ2: Has 100% of the measure been installed where possible?

  • CWI-1: Is the insulation material suitable for use with the property’s exposure level to wind driven rain?

  • CWI-2: Is the insulation material suitable for use with the property’s exposure level to wind driven rain?

  • CWI-3: Does the current condition of the property suggest that it was suitable for the material that has been installed?

  • CWI-4: Does the drilling pattern conform to the appropriate materials compliance certificate?

  • CWI-5: Have all injection holes been filled?

  • CWI-6: Have all vents been safeguarded and have redundant vents been sealed?

  • CWI-7: Is there any evidence of the escape of insulation?

  • CWI-8: Are there any signs of damp or condensation?

  • CWI-9:If the cavity wall contains pre-existing insulation, is the additional insulation to be added compatible with the pre-existing insulation as demonstrated by the product certificate?

  • HSCWI-1: Are combustion vents/flues/chimneys clear of insulation and in compliance with HSE/CIGA guidance?

  • HSCWI-2: Have combustion air core vents been fitted where required?

  • HSCWI-3: Are all the air bricks and eaves vents clear of insulation material and sleeves installed where appropriate?

  • HSCWI-4: Do any faults specific to the measure installed present an immediate risk to the occupier?

  • HSCWI-5: Do you believe that there are no other safety related issues with the installation?

  • PHOTO EVIDENCE

  • CAVITY TM PHOTO EVIDENCE

  • Front door showing door number

  • Front door open

  • Elevations - all required - taken front on where possible, include any return walls.

  • Front and rear elevation to show full height to ridge line including guttering and down pipes

  • DPC - photo of each elevation showing the DPC and its height above the ground level (including presence of any features such as adjacent decking, slopes, raised beds, soakaways etc).

  • Vents - photos of each combustion ventilation, if applicable, floor and wall vents

  • Trickle vents in windows and any other type of extractor fan

  • Guttering and downpipes - all elevations

  • Loft showing internal wall substrate and cavity head

  • Primary heating source

  • Tertiary heating source (if present)

  • Photograph of location for any redundant flues

  • Internal rooms and external heat loss walls

  • Building defects including spalled, damaged brickwork and cracks

  • Ivy and any other vegetation on property

  • Close up of all waste pipes exiting through the cavity to check seal around pipe

  • Working at height issues - for example, conservatory

  • Omitted areas not to be filled

  • Gas meter box

  • Inside electric meter box

  • Any other obstructions exiting through the cavity, for example, cables, extractor fans etc

  • LOFT TM QUESTIONS

  • TMQ1: Have all avoidable thermal bridges/heat loss areas which could have been insulated, been insulated ?

  • TMQ2: Has 100% of the measure been installed where possible?

  • LI-1: Is the thickness of insulation consistent throughout the loft area?

  • LI-2: Has insulation been close butted?

  • LI-3: Has insulation been cross laid to prevent cold bridging?

  • LI-4: Has the loft hatch been insulated as specified in in the relevant PAS annex?

  • LI-5: Has the loft hatch been draught proofed as specified in the relevant PAS annex?

  • LI-6: Where down lighters or services have been fitted through the existing ceiling, have any measures been taken to prevent air leakage around down lights into roof void?

  • LI-7: Have any and all working pipes and tanks been properly insulated?

  • HSLI-1: Are electric cables safeguarded in accordance with PAS2030?

  • HSLI-2: Are downlights safeguarded in accordance with PAS2030?

  • HSLI-3: Are other electrical apparatus penetrating the ceiling safeguarded in accordance with PAS2030-2012?

  • HSLI-4: Is there clearance between the insulation and flues and chimneys in accordance with PAS2030?

  • HSLI-5: Have all essential ventilation openings been safeguarded in accordance with PAS 2030?

  • HSLI-6: Is a walkboard fitted in accordance with PAS2030?

  • HSLI-7: Are warning signs fitted in accordance with PAS2030?

  • HSLI-8: Do any faults specific to the measure installed present an immediate risk to the occupier?

  • HSLI-9: Do you believe that there are no other safety related issues with the installation?

  • PHOTO EVIDENCE

  • LOFT TM PHOTO EVIDENCE

  • Front elevation to include door number and open front door

  • Loft hatch closed

  • Loft hatch open

  • Loft hatch rebate showing presence of draught proofing

  • Back of loft hatch showing insulation (including measurement of correct depth)

  • Various photos showing all angles of the loft space

  • Clear measurement of the insulation thickness

  • Original insulation

  • Ceiling photos to show all parts of underside of loft area – to identify lighting

  • Bathroom and shower photo (include electric shower cord pull location)

  • Photographs of mechanical ventilation present in all wet-rooms

  • Airing cupboard door open (showing ceiling with any penetrating pipework) and closed

  • Roof outside (each elevation)

  • External elevation photos (all elevations)

  • Ridges and tile vents (if applicable)

  • Pipes in loft

  • Tanks in loft

  • Roof lining (enough photos to show all parts of roof)

  • Exposed timbers

  • F rated caps if fitted

  • Warning and Notification signs fixed to roof joists

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.