Information

  • Site

  • Postcode:

  • Job Number Reference

  • URN Number (Six Digit Unique number)

  • Opened Date on FIRAS database (if applicable)

  • Walk Off by:

  • Date of Walk Off:

Certificate of Conformity

  • This certificate is issued by the contractor in accordance with the SCCI Alphatrack Fire Safety Procedure to indicate the compliance of a fire resistant installation. It confirms that the project has been completed having full regards to the requirements of the appropriate product specification and its installation/application instructions and that the claimed performance is substantiated by appropriate British Standard testing and/or assessment evidence.

Fire Stopping

  • Name of Client

  • Name of Landlord

  • Building Type

  • Number of Floors

  • Number of holes made in concrete / brick

  • Number of holes made in Fireboard / existing fire rated material

  • Product in use

  • Details

  • Product Batch Number

  • Manufacture Date

  • Expiry date

  • Provide photograph

  • Any additional items of work / product used. Provide details

  • Any existing untreated holes - provide details (location / floor )

  • Provide photographs

Photographs

  • Hole 1 - Floor / Location

  • Before

  • After

  • Hole 2 - Floor / Location

  • Before

  • After

  • Hole 3 - Floor / Location

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  • After

  • Hole 4 - Floor / Location

  • Before

  • After

  • Hole 5 - Floor / Location

  • Before

  • After

  • Additional Holes

  • Hole 6 - Floor / Location

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  • After

  • Hole 7 - Floor / Location

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  • After

  • Hole 8 - Floor / Location

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  • After

  • Hole 9 - Floor / Location

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  • After

  • Hole 10 - Floor / Location

  • Before

  • After

  • Additional Holes

  • Hole 11 - Floor / Location

  • Before

  • After

  • Hole 12 - Floor / Location

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  • After

  • Hole 13 - Floor / Location

  • Before

  • After

  • Hole 14 - Floor / Location

  • Before

  • After

  • Hole 15 - Floor / Location

  • Before

  • After

  • Additional Holes

  • Hole 16 - Floor / Location

  • Before

  • After

  • Hole 17 - Floor / Location

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  • After

  • Hole 18 - Floor / Location

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  • After

  • Hole 19 - Floor / Location

  • Before

  • After

  • Hole 20 - Floor / Location

  • Before

  • After

  • Additional Holes

  • Hole 21 - Floor / Location

  • Before

  • After

  • Hole 22 - Floor / Location

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  • After

  • Hole 23 - Floor / Location

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  • After

  • Hole 24 - Floor / Location

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  • After

  • Hole 25 - Floor / Location

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  • After

  • Hole 26 - Floor / Location

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  • After

  • Hole 27 - Floor / Location

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  • After

  • Hole 28 - Floor / Location

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  • After

  • Hole 29 - Floor / Location

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  • After

  • Hole 30 - Floor / Location

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  • After

  • Hole 31 - Floor / Location

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  • After

  • Hole 32 - Floor / Location

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  • After

  • Hole 33 - Floor / Location

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  • After

  • Hole 34 - Floor / Location

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  • After

  • Hole 35 - Floor / Location

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  • After

  • Hole 36 - Floor / Location

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  • After

  • Hole 37 - Floor / Location

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  • After

  • Hole 38 - Floor / Location

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  • After

  • Hole 39 - Floor / Location

  • Before

  • After

  • Hole 40 - Floor / Location

  • Before

  • After

  • Additional Holes

  • Hole 41 - Floor / Location

  • Before

  • After

  • Hole 42 - Floor / Location

  • Before

  • After

  • Hole 43 - Floor / Location

  • Before

  • After

  • Hole 44 - Floor / Location

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  • After

  • Hole 45 - Floor / Location

  • Before

  • After

  • Hole 46 - Floor / Location

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  • After

  • Hole 47 - Floor / Location

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  • After

  • Hole 48 - Floor / Location

  • Before

  • After

  • Hole 49 - Floor / Location

  • Before

  • After

  • Hole 50 - Floor / Location

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  • After

  • Hole 51 - Floor / Location

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  • After

  • Hole 52 - Floor / Location

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  • After

  • Hole 53 - Floor / Location

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  • After

  • Hole 54 - Floor / Location

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  • After

  • Hole 55 - Floor / Location

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  • After

  • Hole 56 - Floor / Location

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  • After

  • Hole 57 - Floor / Location

  • Before

  • After

  • Hole 58 - Floor / Location

  • Before

  • After

  • Hole 59 - Floor / Location

  • Before

  • After

  • Hole 60 - Floor / Location

  • Before

  • After

  • Additional Holes

  • Hole 61 - Floor / Location

  • Before

  • After

  • Hole 62 - Floor / Location

  • Before

  • After

  • Hole 63 - Floor / Location

  • Before

  • After

  • Hole 64 - Floor / Location

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  • After

  • Hole 65 - Floor / Location

  • Before

  • After

  • Hole 66 - Floor / Location

  • Before

  • After

  • Hole 67 - Floor / Location

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  • After

  • Hole 68 - Floor / Location

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  • After

  • Hole 69 - Floor / Location

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  • After

  • Hole 70 - Floor / Location

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  • After

  • Hole 71 - Floor / Location

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  • After

  • Hole 72 - Floor / Location

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  • After

  • Hole 73 - Floor / Location

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  • After

  • Hole 74 - Floor / Location

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  • After

  • Hole 75 - Floor / Location

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  • After

  • Hole 76 - Floor / Location

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  • After

  • Hole 77 - Floor / Location

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  • After

  • Hole 78 - Floor / Location

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  • After

  • Hole 79 - Floor / Location

  • Before

  • After

  • Hole 80 - Floor / Location

  • Before

  • After

Sign Off

Sign Off

  • Additional Notes / Information

  • Contractor Name

  • Contractor Address

  • Contractor Contact Details

  • Operative

  • Supervisor

  • Completed Sign Off

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.