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

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 2 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 3 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 4 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 5 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Additional Holes

  • Hole 6 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 7 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 8 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 9 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 10 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Additional Holes

  • Hole 11 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 12 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 13 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 14 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 15 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Additional Holes

  • Hole 16 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 17 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 18 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 19 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 20 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Additional Holes

  • Hole 21 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 22 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 23 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 24 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 25 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 26 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 27 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 28 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 29 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 30 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 31 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 32 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 33 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 34 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 35 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 36 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 37 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 38 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 39 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 40 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Additional Holes

  • Hole 41 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 42 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 43 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 44 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 45 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 46 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 47 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 48 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 49 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 50 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 51 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 52 - Floor / Location

  • Size of hole / penetration (mm)

  • Depth of fire stopping (mm)

  • Before

  • After

  • Hole 53 - Floor / Location

  • Before

  • After

  • Hole 54 - Floor / Location

  • Before

  • After

  • Hole 55 - Floor / Location

  • Before

  • After

  • Hole 56 - Floor / Location

  • Before

  • 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

  • Before

  • After

  • Hole 65 - Floor / Location

  • Before

  • After

  • Hole 66 - Floor / Location

  • Before

  • After

  • Hole 67 - Floor / Location

  • Before

  • After

  • Hole 68 - Floor / Location

  • Before

  • After

  • Hole 69 - Floor / Location

  • Before

  • After

  • Hole 70 - Floor / Location

  • Before

  • After

  • Hole 71 - Floor / Location

  • Before

  • After

  • Hole 72 - Floor / Location

  • Before

  • After

  • Hole 73 - Floor / Location

  • Before

  • After

  • Hole 74 - Floor / Location

  • Before

  • After

  • Hole 75 - Floor / Location

  • Before

  • After

  • Hole 76 - Floor / Location

  • Before

  • After

  • Hole 77 - Floor / Location

  • Before

  • After

  • Hole 78 - Floor / Location

  • Before

  • 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.