Title Page
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Name and Site
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Site Address
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Report Prepared by
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Date Prepared
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Date Installed/Job No
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Product Type and Unit/Location
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Date and How was it reported by Client:
GLASS BREAKAGE / DISLODGEMENT REPORT
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Instructions
1. Please answer the questions accordingly
2. Add Photos and Notes by clicking on the Paperclip icon
3. To add a Corrective Measure click on the Paperclip icon then ""Add Action"", provide a description, assign to a member, set priority, and due date
4. Complete audit by providing digital signature
5. Share your report by exporting as PDF, Word, Excel or Web Link -
This report is required to be prepared to record all available information where installed glass is broken or, dislodged without breakage, in any Stegbar or Regency showerscreen framed, semi framed and frameless type.
The report should also be prepared and submitted where breakage to a window or door is reported where any injury occurs.
In all instances this report is to be submitted within 48 hours.
Good quality digital photographs are to be taken from a number of angles to record the circumstances and the layout of the area where breakage occurred.
Close-ups should be taken of hinges or other hardware. The digital photographs should be attached to the email accompying the report.
Where an injury occurs, a Third Party Incident Report - form 089 is to be prepared and forwarded, within 24 hours, to the Senior Group Controller.
Where glass dislodgement/breakage occurs checks should be made during the initial site inspection with the objective of determining why the breakage has occurred. Refer Section A below.
Section A
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Product type
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Shower screen type
- Grange In-line
- Grange Overlap
- Semi framed pivot
- Framed pivot
- Framed slider
- Frameless
- Aqua Deluxe/Pivot
- Grange Slider
- Other
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•Specify Other shower screen type
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The following checks should be made to determine the reason for the breakage -
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1. Check that the hinges, clips, sill block/s and head block/s are securley fixed.
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2. Check that the top rail is securely fixed to the head of the fixed glass.
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3. Check that the fixed side lite is securely fixed.
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4. Check for obsticles/impacted - glass, rose, rails.
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NOTE: Where broken glass is replaced, a check must be made to determine that the correct clearance exists between the replaced panel and the adjacent panel and other panels on the screen/s. This is critical on partly framed and frameless showerscreens.
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Describe the circumstances surrounding the breakage/dislodgement
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•Take Photo/Attach reference
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Did the glass break
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Did the glass break safely
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Date and Time broken
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Glass thickness
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Glass type
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Is the cause of breakage/dislodgement evident:
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•Provide the details
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Date of Inspection
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Inspection by
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Was anyone injured
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Male/Female
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Approx. age
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Describe the nature of the injury:
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Was the person given hospital treatment
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Original email to - Senior Group Controller
Copies to - R&D@jeld-wen.com.au, V.P for Unit involved, Unit State Manager, Director of Business Services and retained by the initiator
Signatory
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Report Prepared by: (Full Name and Signature)
