Information

  • Record additional work activities. (PAS Ventilation, Plumbing, moving items, Non PAS action s

  • Select activities

Media

  • Add all VIDEOS

  • Add all GPS survey photos

  • Location
  • First line of address

Major Issue Highlight

  • Major issue(s) to highlight? (Extra awareness or non standard issues not covered adequately in survey)

  • DETAIL MAJOR ISSUE OR ACTION REQUIRED

  • Give a Headline to topic

  • Give a description of issue, add photos and drawings

  • What trade would best address the issue?

  • Have you sort a solution from a internal team member whilst at dwelling?

  • Who?

  • Write notes about the solution. Add VIDEO, notes, drawings, photos

  • Is there a 2nd major issue to report?

  • DETAIL MAJOR ISSUE OR ACTION REQUIRED

  • Give a Headline to topic

  • Give a description of issue, add photos and drawings

  • What trade would best address the issue?

  • Have you sort a solution from a internal team member whilst at dwelling?

  • Who?

  • Write notes about the solution. Add VIDEO, notes, drawings, photos

  • Is there a third major issue to report?

  • DETAIL MAJOR ISSUE OR ACTION REQUIRED

  • Give a Headline to topic

  • Give a description of issue, add photos and drawings

  • What trade would best address the issue?

  • Have you sort a solution from a internal team member whilst at dwelling?

  • Who?

  • Write notes about the solution. Add VIDEO, notes, drawings, photos

  • Is there a forth major issue to report?

  • DETAIL MAJOR ISSUE OR ACTION REQUIRED

  • Give a Headline to topic

  • Give a description of issue, add photos and drawings

  • What trade would best address the issue?

  • Have you sort a solution from a internal team member whilst at dwelling?

  • Who?

  • Write notes about the solution. Add VIDEO, notes, drawings, photos

  • Is there a fifth major issue to report?

  • DETAIL MAJOR ISSUE OR ACTION REQUIRED

  • Give a Headline to topic

  • Give a description of issue, add photos and drawings

  • What trade would best address the issue?

  • Have you sort a solution from a internal team member whilst at dwelling?

  • Who?

  • Write notes about the solution. Add VIDEO, notes, drawings, photos

  • Is there a sixth major issue to report?

  • DETAIL MAJOR ISSUE OR ACTION REQUIRED

  • Give a Headline to topic

  • Give a description of issue, add photos and drawings

  • What trade would best address the issue?

  • Have you sort a solution from a internal team member whilst at dwelling?

  • Who?

  • Write notes about the solution. Add VIDEO, notes, drawings, photos

Property details

  • Address.

  • Survey conducted by.

  • Are we the lead installer responsible for PAS and funding claim?

  • Customer Name:

  • Tenure.

  • Contact Details and Type

  • House Type.

  • Property Type

  • Number of Bedrooms.

  • Construction age of the property.

  • Main Heating type : Take photos of the appliance and the rating plate or appliance ID.

  • Location of the flue.

  • Secondary heating.

  • If secondary heating present please take a photo.

  • Structural Condition of the roof.

  • External Condition of the building.

  • Remedial Works Required (Property fabric) (not amend current)

  • If yes please give details of remedial work required plus photos.

  • Have you done an internal inspection of the building.

  • If you have answered yes please select the best description of your findings.

  • Please take photos of your internal findings.

  • Safety monitors present.

  • Have the alarms all been tested by surveyor.

  • Protected species, non domestic birds or rodents present in building ?

  • Special Instructions.

Access

  • On site parking notes : Availability, Restrictions

  • Client Instructions.

  • Access Issues (parking to dwelling)

  • Installer Access Equipment Required (non standard) (not tele ladder/stand up box)

High Voltage Cable (s) & Condition report

  • High voltage cables in the area to be treated?

  • Select the statement (s) that best represents the issue?

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

General electric - (expand )

  • HC in work space?

Combustion Ventilation Evidence and actions required

  • Combustion ventilation appliance (s) to evidence?

  • Select the appliance to record (repeat for every appliance in the dwelling)

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

  • Combustion ventilation appliance (s) to evidence?

  • Select the appliance to record (repeat for every appliance in the dwelling)

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

  • Combustion ventilation appliance (s) to evidence?

  • Select the appliance to record (repeat for every appliance in the dwelling)

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

  • Combustion ventilation appliance (s) to evidence?

  • Select the appliance to record (repeat for every appliance in the dwelling)

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

Gas Safe work required (by our team)

  • Amendment to gas safe appliance, pipes etc required by internal team?

  • Select the statement (s) that best represents the issue?

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

Plumbing - Radiator system and H&C

  • Amendment(s) to Tails, Radiator plan, drops, radiators, Water supply (toilets, baths, sinks, appliances)?

  • Select the statement (s) that best represents the issue?

  • How many sets of tails?

  • undefined

  • How many Radiators to remove

  • How many to remove and refit

  • How many radiators flow and return pipe sets to be removed (drops, long runs)

  • Linear meter of waste pipe

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

Windows (doors), sills, Shirking preparation

  • Complete question set of windows (doors), sill detail, preparation

  • Select the statement (s) that best represents the issues?

  • Depth of sills/reveals (record in room detail if varied) CM

  • undefined

  • Give detail and add a video plus photos of the issue

  • How many windows and door reveals have this issue

  • How many windows and doors need plaster removing to fit board (jacko)

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • How many windows and doors in total at the dwelling (walls only not RIR/slope)

  • How many windows and doors in the area to be treated

  • Record detail of shirking board actions required (will come off and go back - expand)

Move, store, remove furniture plan

  • Reflect discussion with resident about furniture, moving, storage and fixed items to be removed (Highlights - details in Room survey, video, photos

  • Select the statement (s) that best represents the issue?

  • Add additional information, video, photos and diagrams to demonstrate action required? (if anything to highlight or record in room)

  • Please share the general plan or options discussed with resident

Ventilation - Short

  • Are we installing PAS Ventilation stratergy

  • Add photo of Ventiation form

  • Number of Door undercuts required

  • Number of trickle vents in habitable rooms (based on continuous extraction MEV)

  • How many wet rooms require Continuous extraction MEV to be installed?

  • How many wet rooms have a suitable core vent or air brick that can be utilised (avoiding core drill)

  • For clarity, how many core vents holes require drilling?

  • Do any rooms have condensation issue

  • How many rooms

  • Will the installation of PAS Ventilation and measures cure the condensation

  • Record more detail, video, photos

DAMP to be expanded (deal with at dwelling as major factor)

  • Discuss DAMP whilst at the property with resident and management (quiz pattern)

  • VIDEO, Photos, notes from discussion

  • Manager review notes to be added post survey

  • Manager review notes to be added post survey section 2

Whole dwelling

  • Image of window references and external diagram

  • Add screen shot of net area to be treated with rooms reference

  • Images of Aerial floor plan showing perimeter to be treated

  • External images of dwelling, DPC, 100% of wall area

  • Net wall area (Whole dwelling walls minus windows)

  • Net wall area to be treated

  • Net wall area NOT to be treated

  • How many rooms (and zones) to report (max room reports below)

Room 1

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 2

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 3

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 4

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 5

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 6

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 7

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

room 8

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 9

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 10

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

room 11

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 12

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

room 13

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

room 14

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 15

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

room 16

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Room 17

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

room 18

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

room 19

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

room 20

  • Select applicable rooms

  • What is the net install wall area of this room (do not include reveals)

  • All room diagrams of walls, videos, photos

  • Is this room to be treated

  • Is this room included in an Awareness or Major report

  • Which trade would best address the issue? (test)

  • Record bespoke plan for room?

  • Room bespoke Furniture/ storage plan

  • Add note and include in video, photos, voice note

  • Room bespoke Fix item move, fixed item install plan

  • Add note and include in video, photos, voice note

  • Room bespoke Window plan

  • Add note and include in video, photos, voice note

  • Room bespoke Gas Safe Requirement

  • Add note and include in video, photos, voice note

Partner Overlap

  • Major appliances are in the work area which are to be removed by partner company (boiler, cylinder)

  • Select the statement (s) that best represents the issue?

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

Inter-floor

  • Is the dwelling two storey (not including RIR) with a space between floors

  • Select the statement (s) that best represents the issue?

  • Add additional information, video, photos and diagrams to demonstrate action required?

  • Select applicable rooms

Loft Insulation

Loft Insulation.

  • Is loft to be insulated ?

  • Photos of all loft hatches and access point(s)

  • Hatch material and insulation plan?

  • Is a loft hatch present and accessible?

  • Is the hatch suitable to prevent moisture and able to be draughtproofed?

  • Details of hatch required (hatch only or hatch and surround)?

  • Loft Hatch Size required?

  • Will a steel combustion flue pass through the loft space?

  • Loft hatch needing D/P

  • Electrical wiring free from visual defects?

  • Are there any high voltage cables in the loft space?

  • If YES please select the type of cable.

  • Loft Height at Centre

  • Area to be insulated.

  • Existing Depth.

  • Photo of existing depth.

  • Depth to be added.

  • In your opinion should loft insulation be Rolled or Blown?

  • Pipes and Tanks Present requiring lagging?

  • Details of Pipes and Tanks to be insulated

  • Down lights present in ceiling?

  • Details of down lights, location/rooms

  • Are any existing down light covers fitted?

  • If YES are these down light covers fire rated to the correct standard?

  • Are there halogen bulbs fitted?

  • Can you see the IP rating on the casing?

  • Please take a photo of the down light IP rating.

  • Loft Survey Image - Plan

  • Relay Required - amended to ensure no patches (bare plaster) and meets cold bridge?

  • Describe work required, location and instruction.

  • Area of amendment required? (Consider labour, time to amend existing insulation material.)

  • Additional notes for relay work

  • Area of additional fibreglass required? (no additional charge if topping up)

  • Loft vents required ?

  • Areas to be omitted ?

  • Does the loft have any existing boarding ?

  • If YES can we insulate at lease 2/3 of the loft space ?

  • Has the boarded area got insulation under it ?

  • If not insulated under, are the joist tunnels tightly sealed with insulation at the ends ?

  • Is a Walkway required ?

  • Details of walkway

  • Loft clearance (customer belongings) ?

  • Details of loft clearance

  • How many man hours estimated for clearance ?

  • Select customer instruction

If funding available please answer additional ventilation questions below.

  • Ventilation Survey ? If responsible for funding, select YES.

  • Are there any visible signs of surface condensation or damp ?

  • Does the property meet the minimum acceptable ventilation requirements set out in PAS 2035?

  • Does the cooker have a hood which ventilates to the outside?

  • Is there an airing cupboard or drying room ventilated to the outside?

  • Is there a tumble dryer which is vented to the outside of the property?

  • Do all wet rooms have as a minimum some form of passive or purge ventilation? (opening windows, air bricks or trickle vents)

  • Do all wet rooms have closing doors?

  • Is there a passive ventilation system?

  • Is there a mechanical ventilation system? (Continuous mechanical extract ventilation / Continuous mechanical ventilation with heat recovery)

  • Is there evidence of intermittent heating to parts of the property ? E.g. TRV's being turned down too low in unused areas.

  • Are there appropriate controls in place to regulate the heating in the property?(thermostat, programmer etc.)

  • Is the thermostat set to a minimum of 10° Celsius in all parts of the property that are heated?

  • Is there evidence of clothes being dried in the property?

  • Are there more bedrooms than occupants?

  • Is there single glazing at the property?

  • Has the importance of behaviour to moisture and condensation been explained to the occupants and information been left behind?

  • Is a condensation calculation required? If so which elements?

Cold Bridge to meet EWI

  • Is cold bridge insulation to be installed?

  • Can we install 50mm of rigid insulation to board to 100% of the perimeter leaving the ventilation gap?

  • If no, why not? Is there a solution (known options, roof etc.)

  • What is the joist depth?

  • What are the joist centres?

  • Which description best matches the property?

  • Total linear metre(s) to be installed? (to one decimal place)

  • Is there any additional work required? Describe work + estimate time + material needed

Plastic (felt cuts)

  • Are plastic cuts for ventilation required (NCA housing only) ?

Door undercuts

  • Are door undercuts required ?

  • How many?

  • Which rooms

Dynamic Risk Assessment & Client Declaration

Dynamic Risk Assessment.

  • Please select yes if loft insulation work to be undertaken.

  • Reversing vehicle ?

  • Asbestos present ?

  • Overhead electricity cables ?

  • Use of an extendable ladders (internal or external) required ?

  • Use of a non-extendable ladder required ?

  • Use of access equipment required?

  • Manual Handling assessment required ?

  • Hand tools, passive and mechanical used ?

  • Vibration risk - from tool use ?

  • Noise - protection required (>85db mandatory) ?

  • House keeping (Dust sheets, cleaning equipment)

  • Lone worker assessment required?

  • I have assessed the conditions on site, there is adequate ventilation, no evidence of damp and no remedial works is required. Unless listed below, there are no additional significant hazards observed that are not addressed in the generic risk assessment prepared for the work to be undertaken.

  • Assessor signature

Installation checks to be completed by technician after the work as been completed.

  • Ignore - Please select yes if loft insulation work to be installed.

  • Crew leader name:

  • No 2 technician:

  • Date.

  • Crew leader signature.

  • Materials used:

  • Roll Matt 100mm

  • Roll Matt 150mm

  • Roll Matt 170mm

  • Roll Matt 200mm

  • Roll Matt 250mm

  • Roll Matt 270mm

  • Roll Matt 300mm

  • Pipe lagging 15mm

  • Pipe lagging 22mm

  • Pipe lagging 28mm

  • Pipe wrap per metre

  • Cold water tank jacket small

  • Cold water tank jacket medium

  • Cold water tank jacket large

  • Hot water tank jacket

  • Poly wedges installed

  • Customer signature:

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.