FM Clearance Survey - Empty Homes

• Location
  Address

• Conducted on

  Date

• Prepared by

  Alan Boland

  Chris Sage

  Paul McDermott

  Other

• Livv Job Number

• Property Type

  Bungalow

  Ground Floor Flat

  Upper Floor Flat

  House

  High Rise Block

• Number of Bedrooms

• Is the Property Empty?

  Yes

  No

  N/A

• Is the Property Legally Void

  Yes

  No

  N/A

• Have the Electrics been made Safe?

  Yes

  No

  N/A

• Has the Gas been made Safe?

  Yes

  No

  N/A

• Are the any initial signs of Infestation, Fleas, Rats?

  Select Infestation Fleas Rats NO

  • Infestation
  • Fleas
  • Rats
  • NO

Environmental Hazards

• Is there any signs of Environmental Hazards?

  Yes

  No

  N/A

• Please confirm hazards

  Animal Fluids / Waste

  Human Fluids / Waste

  Sharps / Syringes

  Flammables

• Is the property showing any significant signs of Damp & Mould?

  Yes

  No

  N/A

White Goods & Furniture

• Is there any White Goods to be removed?

  Yes

  No

  N/A

• How many White Goods?

• Is there any Furniture to be removed?

  Yes

  No

  N/A

• Approximate number of Furniture items

• Is there any Mattresses to be removed?

  Yes

  No

  N/A

• How many Mattresses?

• Is there any Clothing inside the property?

  Yes

  No

  N/A

Flooring

• Are there any Carpets?

  Yes

  No

  N/A

• Please describe which rooms have carpets to be removed

• Is there any Laminate Flooring in Poor Condition to be removed?

  Yes

  No

  N/A

• Please describe which rooms to have laminate removed

• Please identify which rooms have Laminate Flooring in Good Condition which is to be left in place

• Is there any Floor Tiles to be removed?

  Yes

  No

  N/A

Loft

• Is there a Loft?

  Yes

  No

  N/A

• Is there any items to be removed from the Loft?

  Yes

  No

  N/A

Front Garden

• Please describe the ownership of the Front Garden

  Private

  Communal

  N/A

• Please provide a picture of front garden condition

  Media

• Is there any items to be removed from the front garden?

  Select Bikes Gas Bottles Tyres Fly Tipping Garden Furniture Childs Toys Other N/A

  • Bikes
  • Gas Bottles
  • Tyres
  • Fly Tipping
  • Garden Furniture
  • Childs Toys
  • Other
  • N/A

Rear Garden

• Please describe the ownership of the Rear Garden

  Private

  Communal

  N/A

• Please provide a picture a the rear garden

  Media

• Is there any items to be removed from the rear garden?

  Select Bikes Gas Bottles Tyres Fly Tipping Garden Furniture Childs Toys Other N/A

  • Bikes
  • Gas Bottles
  • Tyres
  • Fly Tipping
  • Garden Furniture
  • Childs Toys
  • Other
  • N/A

Outbuildings

• Is there any Outbuildings?

  Yes

  No

  N/A

• Do they require emptying?

  Yes

  No

  N/A

Bins

• Are there any KMBC bins?

  Yes

  No

  N/A

Heath & Safety

• Are there any Heath & Safety issues to be raise?

  Yes

  No

  N/A

• How would you rate the volume of the contents within this property?

  Small

  Medium

  Large

• Does the property require a specialist clearance?

  Yes

  No

  N/A

• Please provide some comments on why a specialist clearance

• Pre-Clearance survey completed by

  Sign