EVOLVE PRE-WORK AND RISK ASSESSMENT

• Measure carried out?

  Select Cavity Wall Loft Extraction Trickle Vents Party Wall Insulation Underfloor Insulation Cancellation Other

  • Cavity Wall
  • Loft
  • Extraction
  • Trickle Vents
  • Party Wall Insulation
  • Underfloor Insulation
  • Cancellation
  • Other

• First Line of Address

• Postcode

• Clients Address
  Address

• Installation Date

  Date

• Crew

• Crew Leader Full Name

• Measure carried out?

  Select Cavity Wall Loft Extraction Trickle Vents Party Wall Insulation Underfloor Insulation Cancellation Other

  • Cavity Wall
  • Loft
  • Extraction
  • Trickle Vents
  • Party Wall Insulation
  • Underfloor Insulation
  • Cancellation
  • Other

• Pre-Works Script

• Confirm with Client they have received pre-works letter/information

  Yes

  No

• Hand Client Laminated copy and ask client to read through, once client has read go through the following.

• Closing all Windows?

  Yes

  No

• Allowing access to all crews

  Yes

  No

• The need for us to seal up for potential ingress

  Yes

  No

• Remove all ornaments or light objects from all window sills and off all external walls

  Yes

  No

• Will remove all movable objects that could be in the crews way or against any external walls ( any objects that cant be moved please ask the crew to move them for you)

  Yes

  No

• I will report any ingress to the crew immediately ( the crew will then preform a clean up)

  Yes

  No

• I have read the letter issued to me by the Evolve crew and fully understand all aspects of the work being carried out.

• Name and Signature

  Sign

• Cavity Wall and Extraction Risk Assessment

• Reversing Vehicle required?

  No

  Yes

• Is Asbestos present?

  No

  Yes

• If YES, is it likely to be disturbed?

  No

  Yes

• Provide further detail if Asbestos present.

• Overhead Cables Present?

  No

  Yes

• Working On roof required?

  No

  Yes

• Has the property got an extension?

  No

  Yes

• Has the property got a garage?

  No

  Yes

• Has the property got a porch?

  No

  Yes

• Has the property got a conservatory?

  No

  Yes

• Access equipment required:

  No

  Yes

• Type Of Access equipment

  Select Mewp Scaffold Mobile Scaffold Other

  • Mewp
  • Scaffold
  • Mobile Scaffold
  • Other

• Access equipment used?

• Location of Gas and Electric meters

  No

  Yes

• Use of Step Ladders required?

  No

  Yes

• Use of Ladders Required?

  No

  Yes

• Manual Handling required?

  No

  Yes

• Hand Tools required?

  No

  Yes

• Vibration likely?

  No

  Yes

• High noise levels likely?

  No

  Yes

• Housekeeping required?

  No

  Yes

• Is there an outside tap?

  Yes

  No

• Working with wet cement/ concrete/ mortar required?

  No

  Yes

• Access from road/ around property

  Good

  Fair

  Poor

• Distance from van to property? (M)

• Will public walkway be put at risk?

  No

  Yes

• Will safety signage be required?

  No

  Yes

• Has property been checked for Flora and Fauna?

  Yes

  No

• Have all plants and pots been moved or safeguarded?

  Yes

  No

• Are there any signs of vermin?

  No

  Yes

• Any pets or wildlife in direct way of work area?

  No

  Yes

• Have manholes and drains been identified?

  Yes

  No

• Have manholes and drains been safeguarded to avoid any spill into watercourse?

  Yes

  No

• Does vehicle need to go onto grass or field areas?

  No

  Yes

• Has matting been placed to safeguard?

  Yes

  No

• Will any chemicals be used which could contaminate soil?

  No

  Yes

• Has all waste been removed from Site?

  Yes

  No

• Loft Risk Assessment

• Reversing Vehicle required?

  No

  Yes

• Is Asbestos present?

  No

  Yes

• If YES, is it likely to be disturbed?

  No

  Yes

• Provide further detail if Asbestos present.

• Use of stepladder required?

  No

  Yes

• Manual Handling required?

  No

  Yes

• Hand Tools required?

  No

  Yes

• Vibration likely?

  No

  Yes

• High noise levels likely?

  No

  Yes

• Housekeeping required?

  No

  Yes

• Installation of roll mat required?

  No

  Yes

• Installation of walkway required?

  No

  Yes

• Installation of draughtproofing required?

  No

  Yes

• Access through property to hatch?

  Good

  Fair

  Poor

• Will public walkway be put at risk?

  No

  Yes

• Will safety signage be required?

  No

  Yes

• Has property been checked for Flora and Fauna?

  Yes

  No

• Have all plants and pots been moved or safeguarded?

  Yes

  No

• Are there any signs of vermin?

  No

  Yes

• Any pets or wildlife in direct way of work area?

  No

  Yes

• Does vehicle need to go onto grass or field areas?

  No

  Yes

• Has matting been placed to safeguard?

  Yes

  No

• Will any chemicals be used which could contaminate soil?

  No

  Yes

• Has all waste been removed from Site?

  Yes

  No

Health And Safety

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

  Yes

  No

• REPORT DEFECT TO YOUR LINE MANAGER

• What equipment is faulty, and discription of fault?

• Equipment ID

• Photo of equipment showing fault

  Media

• Who have you reported the issue too?

  Select Operations Manager Technical Monitoring Supervisor Other

  • Operations Manager
  • Technical Monitoring Supervisor
  • Other

• Name of person reported to?

• Has property been checked for Smoke Alarms?

  Yes

  No

  N/A

• How Many Smoke Alarms present?

• Have Covers been fitted to Alarms?

  Yes

  No

• Photos of Smoke Alarms with covers fitted

  Media

ACCIDENT AND NEAR MISSES

• Employees shall report all work-related accidents, injuries, illness or unplanned events which could have resulted in an injury or illness.

• Please check box if any work related accident/ near miss has occurred

• I AM REPORTING A WORK RELATED :

  INJURY

  ILLNESS

  NEAR MISS

• Name of Technician concerned

• Date

  Date

• Has your line manager been made aware of this incident?

  Yes

  No
• Location of Incident
  Address

• Witnesses (If Any)

• Incident Description (Describe tasks being performed and sequence of Events.

• What could have been done to prevent this injury/ near miss?

• What injury have you received? If near miss, how could you have been hurt?

• Was medical treatment necessary?

  No

  Yes

• Name of Hospital/ Doctor

• Date and Time of Visit

  Date

• Have you received a similar injury previously?

  No

  Yes

• Please add any photo evidence

  Media

• Please add any additional comments

• Technicians Name and Signature

  Sign

Technician Assessment sign off

• Name and Signature

  Sign