Hazard Identification Sheet

• Harcross ref:

• Hazard Identification Sheet

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

• Personnel present

Survey Details

• Cause

  Select Subsidence EoW Fire Impact Flood Accidental Damage Storm

  • Subsidence
  • EoW
  • Fire
  • Impact
  • Flood
  • Accidental Damage
  • Storm

• Rooms / Areas Affected

  Select Lounge Dining Room Kitchen Bathroom Hall, Stairs & Landing Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Roof Front Elevation Rear Elevation Right Hand Elevation Left Hand Elevation Conservatory Front Garden Area Rear Garden Area

  • Lounge
  • Dining Room
  • Kitchen
  • Bathroom
  • Hall, Stairs & Landing
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Roof
  • Front Elevation
  • Rear Elevation
  • Right Hand Elevation
  • Left Hand Elevation
  • Conservatory
  • Front Garden Area
  • Rear Garden Area

• Type of Property

  Select Detached Mid Terrace End Terrace Semi Detached Garage maisonette Townhouse Flat Annexe

  • Detached
  • Mid Terrace
  • End Terrace
  • Semi Detached
  • Garage
  • maisonette
  • Townhouse
  • Flat
  • Annexe

• Approx. year of construction of the property

• How many bedrooms has the property got?

• Overall condition of property

  Poor

  Average

  Good

• Evidence of Pre-existing / Long term

  Yes

  No

  N/A

• Comment

• Add media

  Media

• Has an insured peril occurred

  Yes

  No

  N/A

• Comment

• Has the damage occurred from one incident?

  Yes

  No

  N/A

• Could the customer have been aware of this damage?

  Yes

  No

  N/A

• If an Escape of Water Claim - Has the leak been fixed

  Yes

  No

  N/A

• If an Escape of Water Claim - Has any damage occurred whilst fixing the leak i.e. T&A?

  Yes

  No

  N/A

• Comment

• Type of Roof

  Flat

  Pitched

  Mono Pitch

  Hipped

  London Roof

• What year do you estimate the construction of the roof

• Approx. Date of last maintenance carried out on roof if applicable

• Is the damage affecting a neighbouring property

  Yes

  No

  N/A

• Does the property require a Drying Specialist

  Yes

  No

  N/A

• Is there evidence of mould, rot or decay

  Yes

  No

  N/A

• Add media

  Media

• Do you think the damage has occurred recently?

  Yes

  No

  N/A

Hazard Declaration

The Insured

• To remain in residence

• Access required during work

• Any specific Health problems to be aware of

• Any other Safety requirements / problems

The Premises / Site

• Adjacent land users - Schools etc

• Existing Services - Underground / overhead

• Stability Issues

• Shared Boundaries / Party Walls

• Trees / Plants

• Proximity to railway, road, public footpath, water courses

• Topography

• Domestic Animals / Farm Animals / Wildlife

• Have you been made aware of Asbestos Containing Material (ACM's) within this building

• Do you suspect ACM's within this building? If your answer is yes, please explain in the box below

• Suspected ACM's

• Fragile Materials

• Other

The Works

• Demolition

• Underpinning

• Piling Work

• Dust, Fumes, etc

• Working at Height

• Access for plant & equipment

• Deliveries / Parking / Skips

• Working in confined spaces

• Adjacent Structures

• Excavations

• Health Hazards

• Basement / Cellars

• Materials - Storage, Disposal, Handling

• Plant, Machinery Risks

• Noise

• Manual Handling

• Electrical Works

The Design

• Materials

• Future Maintenance

• Specific Cleaning Requirements

• Access Difficulties

• Specific Site Rules

• Ground Conditions

• Services

• Hazardous Substances

• Comments on hazard declaration if applicable

• Any Significant Hazards?

  Yes

  No

  N/A

• Standard Working Practices to apply?

  Yes

  No

  N/A