Title Page
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Document No HSCF026
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Conducted on
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Prepared by
1.0 Location Information
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Project Number
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Project Address
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Project Photograph
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Project Start & End Date
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Mobile Phone Signal
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Nearest Hospital
2.0 CDM Information
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2.1 Is the project notifiable, if yes has an F10 been applied for?
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2.2 Who is the Client? Contact details to include Company Name, Contact Name, Address, Tel No: & e-mail
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2.3 Who is the Principal Contractor: Contact details to include Company Name, Contact Name, Address, Tel No: & e-mail
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2.4 Are there any Designers already appointed?
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2.4.1 Mechanical Designer: Contact details to include Company Name, Contact Name, Address, Tel No: & e-mail
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2.4.2 Electrical Designer: Contact details to include Company Name, Contact Name, Address, Tel No: & e-mail
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2.4.3 Construction Designer: Contact details to include Company Name, Contact Name, Address, Tel No: & e-mail
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2.4.4 Designers (Other):
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2.5 Building Control: Contact details to include Company Name, Contact Name, Address, Tel No: & e-mail
3.0 Project Scope
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3.1 Description of the works to be carried out?
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3.2 Estimated No of Contractors? Provide Names.
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3.3 Estimated No of workers on site
4.0 The Existing Environment
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4.1 Provide as much information as possible about the building where the works are to be carried out e.g. number of floors, occupation levels
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4.2 Will the project impact - other building users, adjacent properties or businesses?
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4.3 Are there any services into the work area including Electricity, Water, Gas, Telephone/data, Waste? Are service drawings available?
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4.4 Are there any hazardous materials within the work area, structural limitations/loadings or existing plant
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4.5 Is there an Refurbishment & Demolition survey available for the work area? (if the building was built prior to 2000 a R&D survey will be required)
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4.6 Are there any conditions externally which may impact the works, overhead power lines, ground contamination, soft ground including subsidence, underground services?
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4.7 Arrangements for site traffic (parking) and pedestrian access.
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4.8 Will the project be occupied or partially occupied by the Client?
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4.9 If yes to 4.8 will the works affect these areas e.g. noise, dust, vibration?
5.0 Emergency/Security Arrangement.
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5.1 Is there any information available on existing fire & emergency procedures, including fire plans, fire escape routes, fire assembly points?
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5.2 Are there any flammable or explosive substances stored on site?
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5.3 What existing security arrangements are currently on site?
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5.4 Is there an existing permit to work system operated by the Client?
6.0 Client Specific/Site Wide Elements
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6.1 Are there any drawings available of the building including structural, fire compartmentation, car parks etc?
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6.2 Is there an existing CDM health & safety file for the work area?
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6.3 What are the arrangement's for site access & egress (pedestrians, vehicles, deliveries and emergency services)?
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6.4 Are there any traffic restrictions e.g. access for emergency services, waste disposal, deliveries & one way systems?
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6.5 Location of unloading, laydown skip location and storage areas?
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6.6 Location of any existing welfare facilities which will be made available for the duration of project?
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6.7 Are there any Client or building rules which the Client will implement e.g. fire procedures, permits, security (access codes/fobs?
7.0 Communication
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7.1 What procedures are in place for considering safety implications of ongoing design e.g. Principals Contractor and other contractors work packages?
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7.2 What procedures are in place for dealing with unforeseen eventualities during the construction phase resulting in substantial changes to the initial design?
8.0 Key Performance Indicators (KPI's)
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8.1 Has the Client set specific KPI's for the during the project relating to health safety & the environment e.g. zero accidents, no of safety inspections carried out & toolbox talks delivered.
9.0 Site Specific Hazards
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8.1 Will the works be carried out in an occupied building? If yes provide details.
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8.2 Will the works involve roofworks? If yes provide details.
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8.3 Will the works involve working at height? If yes provide details.
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8.4 Are there any fragile surfaces?. If yes provide details.
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8.5 Wil the works involve asbestos removal? If yes provide details.
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8.6 Did the asbestos survey identify any asbestos containing materials? If yes provide details.
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8.7 Is there a risk site operative's, members of the public could be exposed to hazardous substances e.g. silica dust, fume. If yes please provide details.
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8.8 Will the works generate high noise levels e.g. above 80dB. If yes please provide details.
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8.9 Doe the project involve electrical works? If yes please provide details
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8.10 Will the works involve heat ofr have the potential to generate heat. Please provide details.
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8.11 Will the works involve demolitions? If yes provide details.
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8.12 Are isolations of services required? If yes provide details.
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8.13 Will there be plant e.g. MEWPS, tele handlers operating on site? If yes provide details.
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8.14 Will there be any excavation work carried out during the project? If yes please provide details.
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8.15 Will any work packages require excessive manual handling? If yes provide information.
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8.16 Does the works present a risk to the public, Client or others? If yes provide details?
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9.0 Additional Information
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Provide any additional information which you feel maybe relevant to the project.
