Information

  • Location.
  • First line of the Address.

  • Client Name:

  • Type of Survey

  • Tenure.

  • Contact Details.

  • Property Type.

  • Building Finish.

  • Number of Bedrooms.

  • Construction age of the property.

  • Survey conducted by.

Property details

  • Main Heating type, please take photos of the appliance and the rating plate or appliance ID.

  • Location of the flue.

  • Secondary heating.

  • If secondary heating present please take a photo.

  • Structural Condition of the roof.

  • External Condition of the building.

  • Remedial Works Required.

  • If yes please give details of remedial work required plus photos.

  • Have you do an internal inspection of the building.

  • If you have answered yes please select the best description of your findings.

  • Please take photos of your internal findings.

  • Safety monitors present.

  • Have the alarms all been tested by surveyor.

  • Protected species or rodents present in building.

  • Special Instructions.

Access

  • On site parking.

  • Client Instructions.

  • Access Issues.

  • Access Equipment Required.

Loft Insulation

Loft Insulation.

  • Is loft to be insulated.

  • Photo of loft and access point

  • Area to be insulated.

  • Existing Depth.

  • Photo of existing depth.

  • Depth to be added.

  • Pipes and Tanks Present

  • Details of Pipes and Tanks to be insulated

  • Down lights present in ceiling?

  • Details of down lights, how many and there current location

  • Do they have halogen bulbs fitted.

  • Can you see the IP rating on the casing?

  • Please take a photo of the down light IP rating.

  • Are there any existing down light covers fitted?

  • If YES are they fire rated covers?

  • Electrical wiring free from visual defects?

  • Are there any high voltage cable's in the loft space.

  • If YES please select the type of cable in the loft space.

  • Loft Hatch Size?

  • Loft Area.

  • In your opinion should loft be Rolled or Blown?

  • Loft Height at Centre

  • Does a steel combustion flue pass through the loft space?

  • Relay Required

  • Loft hatch needing D/P

  • Loft vents required

  • Areas to be omitted

  • Does the loft have any boarding?

  • If YES can we insulate at lease 2/3 of the loft space?

  • has the boarded area insulation under it?

  • If not insulated under, are the joist tunnels tightly sealed with insulation at the ends?

  • Walkway required

  • Details of walkway

  • Loft clearance

  • Details of loft clearance

  • Additional notes

Dynamic Risk Assessment & Client Declaration

Dynamic Risk Assessment.

  • Please select yes if loft insulation work as to be installed.

  • Reversing vehicle.

  • Asbestos

  • Overhead electricity cables.

  • Use of a step ladders.

  • Use of a ladder.

  • Manual Handling.

  • Hand tools.

  • Vibration.

  • Noise.

  • House keeping.

  • Use of mobile elevation working platform (mewp) or a scaffold tower.

  • Lone worker.

  • I have assessed the conditions on site ensuring there is adequate ventilation and no evidence of damp and no remedial works required. Unless listed below, there are no additional significant hazards observed that are not addressed in the generic risk assessment for the work to be undertaken.

  • Assessors signature

Installation checks to be completed by technician after the work as been completed.

  • Please select yes if loft insulation work as to be installed.

  • Crew leader name:

  • No 2 technician:

  • Date.

  • Crew leader signature.

  • Materials used:

  • Roll Matt 100mm

  • Roll Matt 150mm

  • Roll Matt 170mm

  • Roll Matt 200mm

  • Roll Matt 250mm

  • Roll Matt 270mm

  • Roll Matt 300mm

  • Pipe lagging 15mm

  • Pipe lagging 22mm

  • Pipe lagging 28mm

  • Pipe wrap per metre

  • Cold water tank jacket small

  • Cold water tank jacket medium

  • Cold water tank jacket large

  • Hot water tank jacket

  • Poly wedges installed

  • Customer signature:

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.