Information
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Customer
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Prepared by
Customer Details
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Company Name
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Customer Contact Requesting Survey
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Account Number
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Initial Platform Hire Contact
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Site Contact
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Date survey was requested
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Address of site
Machine Requirements
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What WORKING HEIGHT is required (m)?
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Is outreach required?
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How much outreach is required (m)?
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Are you booming up and over an object or building?
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At what height do you require the knuckle to reach (m)?
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What is the machine being used to do?
Site Restrictions
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Are there height restrictions?
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What is the height restrictions (m)?
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Is there a width restriction?
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What are the width restrictions?
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Is there a weight restriction?
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What is the weight restictions (m)?
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Is there a length restriction?
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What is the length restriction (m)?
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is there any obstructions or obstacles?
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What obstacles / hazards are there?
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What are the ground conditions / gradients?
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Delivery Restrictions (Truck Access / Timed Access)
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What are the restrictions
Working on a road / pavement
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Type of Road (Private / 30mph / Pedestrian area)
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Permit Likely Required
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Additional Survey Required (Traffic Management / specific machine specialist)
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Notes of 'working on road' restrictions / requirements / comments / observations
Machine Selection
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Date Machine Required
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1st Choice Machine
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Alternative Machine (if possible)
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Date survey taken out
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Was site contact present
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Surveyor Signature
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Site Pictures
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Sketch of site / building