Information

  • Customer address
  • Customer name

  • Conducted on

  • Engineer

  • Job number

Section 2 - Walk though - Before we start - Part 1

  • We want to make sure you are happy with the work. Our engineer will explain what is going to happen, in detail. When you sign the below you're confirming that you're happy for us to start work and understand (and you're happy with) the following;

  • The location/position of new boiler.

  • The location/routing of pipework.

  • Location of the external fuel supply if applicable

  • The location of their new radiators if applicable.

  • The location of their new condensate and flue terminal.

  • The location of the system controls.

  • Customer to sign and confirm satisfaction/understranding

Section 2 - Walk though - Before we start - Part 2

  • You're also confirming that;

  • Customer is responsible for moving furniture to give the engineer full access.

  • Help-link UK LTD or its partners cannot be held responsible if any damage occurs to furniture or belongings moved by our gas engineer at the customers request.

  • You may use loss your gas,electrics or heating for a period of time during the works

  • Customer to sign and confirm satisfaction/understanding

Section 3 - Protect - Before we start - Part 2

  • I confirm that;

  • Engineer has adequately protected my property using floor protectors and dust sheets inc worktops/floors.

  • I have been shown the location of fire extinguishers and sign boards explaining there purpose.

  • Received the 'committed to safety' card and I fully understand.

  • I fully understand the scope of works and I understand the impact it will have on my home.

  • Customer to sign and confirm satisfaction/understanding

Section 4 - Handover

  • We want to make sure you're happy with the work we have done. Small details make a huge difference and no job is complete until our engineer has carried out all the tasks listed below. Please sign and confirm that you are happy with our work.

    I confirm the work has been completed to my satisfaction and the engineer has;

  • Provided me with the operating instructions including Gas Boiler Benchmark Certificate and log book.

  • Explaining what building regulations, electrical inspection and testing certificates will be provided.

  • Removed the old boiler, associated parts, and packaging from my property.

  • Explained how to top up system pressure if applicable.

  • Shown me the location of the isolation valves for the gas/electric/water.

  • Fully explained how to use the boiler and its functions.

  • Fully explained how to use the system controls, including the smart thermostat and associated smart device apps if applicable.

  • Customer to sign and confirm satisfaction/understanding

Site specific ra

  • Hazard - Parking & Offloading
    Who's at risk - Operatives, other workers, visitors, general public
    Risk level - High

  • Control Measures

    • Use designated parking area,
    • Abide by site traffic rules, where applicable
    • Consideration for other traffic, pedestrians etc,

  • Use of banksman for reversing

  • Wear Hi Viz Vest

  • Park off road

  • Switch hazard lights on

  • Risk Rating With Control measures

  • Hazard - Slips, Trips & Falls on the site
    Who's at risk - Operatives, other workers, visitors, general public
    Risk level - Medium

  • Control Measures

    • Good housekeeping and site tidiness
    • Report slip/trip hazards outside your control to management,
    • Ensure good lighting available,
    • Keep cables/pipes tidy,
    • Wear suitable safety footwear

  • Use of look out & verbal instructions

  • Exclude others from work area

  • Use of cones

  • Use of barriers

  • Risk Rating With Control measures

  • Hazard - Manual Handling
    Whos at risk - Operatives, other workers, visitors, general public
    Risk level - Medium

  • Control Measures

    • Unload materials as close to workplace as possible,
    • Use safe manual handling techniques,
    • Limit lifting to 25 kg per person whenever possible,
    • Use mechanisation where possible,
    • Ensure traffic route is clear and well lit

  • Safe lifting techniques

  • Team lifting

  • Use of barrows / trolleys

  • Use of Hi-Ab

  • Use of Tail lift

  • Use of Hoist / Lift

  • Risk Rating With Control measures

  • Hazard - Working at Height
    Whos at risk - Operatives
    Risk level - High

  • Control measures

    • Use the most suitable equipment for working at height (ladders/step ladders only to be used for light work of short duration, ladders for access, and only when it is not practicable to use scaffolding, guarded platforms, towers etc).
    • Factors to take into account- duration of task, weight & size of material handled, tools required, height of operations, surroundings, other trades/ people in area, space availability
    • Top and mid guard rails and toeboards required on edges and access equipment
    • Compliance with safe systems of work for the access equipment used
    • Ensure equipment is well maintained and inspected before use
    • Ensure equipment is tall enough
    • Ensure operatives are trained in the use of equipment
    • Check ground conditions before use
    • Check for overhead services or obstructions
    • Site supervisor to authorise and monitor all working at height
    • For more information refer to relevant sections in general risk assessments and handbook

  • Use of EN131 or Class 1 Steps

  • Use of Towers

  • Use of MEWPs

  • Use of hop ups

  • Use of Scaffolding

  • Use of EN131 or Class 1 ladders

  • Use of fall restraint harnesses

  • Use of restraint harnesses

  • Risk Rating With Control measures

  • Hazard - Falls through fragile surfaces
    Who's at risk - Operatives
    Risk level - High

  • Control measures

    • Priority to be given to preventing access onto any surface which could be potentially unsafe

  • Use of crawling boards

  • Use of temporary decking

  • Barriers around fragile surfaces

  • Lighting in lofts

  • Risk Rating With Control measures

  • Hazard - Falling Objects or Materials
    Who's at risk - Operatives, other workers, visitors, general public
    Risk level - High

  • Control measures

    • Use of tool belts
    • Wear hard hats as necessary
    • Wear safety footwear

  • Put up barriers etc to create safe zone around work area

  • Brick guards of scaffolding

  • Netting on scaffolding

  • Exclude others from work area

  • Use of Warning Signs

  • Risk Rating With Control measures

  • Hazard - Working with electrical equipment
    Who's art risk - Operatives
    Risk level - High

  • Control measures

    • Equipment to be Portable Appliance Tested
    • Equipment subject to inspection before use
    • RCD to be tested before use

  • Use of battery equipment

  • Use of 110 volt equipment

  • Use of 240 volt equipment with RCD

  • Risk Rating With Control measures

  • Hazard - Contact with electrical supplies
    Who's at risk - Operatives
    Risk level - High

  • Control measures

    • Isolation of circuits before undertaking work
    • No live working during installation work
    • Ensure other trades/colleagues/tenants etc cannot introduce power without authorisation
    • All electrical work undertaken by qualified electrician
    • Use of scanner to locate hidden electrical supplies
    • Temporary power supplies installed by qualified electrician to BS7671

  • Removal of fuses to isolate power

  • Switch off circuit breakers to isolate power

  • Lock off procedure to isolate power

  • Use of warning notices

  • Risk Rating With Control measures

  • Hazard - Fire/explosion from gas supplies
    Who's at risk - Operatives, other workers, visitors, general public
    Risk level - High





  • Control measures

    • Work on gas systems undertaken by competent person (ie GAS SAFE Registered Fitter)
    • Gas isolated before work commences

  • Gas isolated by valve

  • Gas isolated by capping off

  • Risk Rating With Control measures

  • Hazard - Handling vibrating equipment
    Whos at risk - Operatives
    Risk level -Medium

  • Control measures

    • Management to select equipment with lowest vibration levels
    • Management to establish duration to which operatives may be exposed to vibrating equipment (hire company can advise) and ensure that they do not exceed the exposure duration
    • Job rotation
    • Hands kept warm through wearing gloves and suitable warm rest faculties to be available

  • Exposure time reduced

  • Job rotation

  • Risk Rating With Control measures

  • Hazard - Hazardous substances
    Who's at risk - Operatives, other workers, visitors
    Riak level - low

  • Control measures

    • Containers clearly marked showing contents
    • Follow manufacturer’s recommendations for handling and storage
    • Have data sheet available for dealing with spills
    • Refer to COSHH assessments

  • Wear eye protection

  • Wear respiratory protection equipment

  • Wear suitable gloves

  • Risk Rating With Control measures

  • Hazard - Work Equipment Hazards
    Whos at risk - Operatives, general public
    Risk level - Medium

  • Control measures

    • Equipment purpose made and suitable for the job
    • Equipment regularly serviced and well maintained
    • Use by trained, authorised operatives
    • Equipment inspected before use
    • Guards and covers used when fitted
    • Equipment stored in vans or storage units when not in use

  • Exclusion of others from work area

  • Use of portable barriers

  • Wear eye protection

  • Wear gloves

  • Wear respiratory protective equipment

  • Risk Rating With Control measures

  • Hazard - Dust
    Who's at risk - Operatives, other workers, visitors, general public
    Risk level - Low

  • Control measures

    • Do not sweep up unless damped down

  • Use dust extraction equipment

  • Use vacuum cleaner

  • Damping down

  • Sweeping as a last resort

  • Risk Rating With Control measures

  • Control measures

    • Fire procedure in place on site
    • Fire extinguishers in vicinity and in van
    • Adequate number of suitable and useable fire exits
    • Site tidiness and good housekeeping
    • Fire procedure covered during induction

  • Hazard - Fire
    Who's at risk - Operatives, other workers, visitors
    Risk level - low

  • Suitable fire extinguishers in vicinity

  • Site specific procedure in place

  • Existing fire precautions & procedures apply

  • Risk Rating With Control measures

  • Hazard - Disturbance of asbestos
    Who's at risk - Operatives, other workers, visitors, general public
    Risk level - Low

  • Control measures

    • Client to provide asbestos register or survey report before work commences. If available.
    • Operatives to have asbestos awareness training

  • Work in areas where no asbestos is present

  • ACMs to be removed before work commences

  • Risk Rating With Control measures

  • Hazard - Noise
    Who's at risk - Operatives, other workers, visitors, general public
    Risk level - Low

  • Control measures

    • Wear hearing protection

  • Limitation on noisy works

  • Selection of equipment with low noise levels

  • Risk Rating With Control measures

  • Hazard - Violence / Aggression
    Who's at risk - Operatives
    Risk level - Low

  • Control measures

    • Policy to avoid confrontation
    • Report concerns to management asap
    • Have mobile phone available to call for help if required
    • If under threat of robbery/missing hand over any articles immediately

  • No lone working

  • No working outside normal work hours

  • Risk Rating With Control measures

  • Hazard - Lone Working
    Who's at risk - Operatives
    Risk level - Med

  • Control measures

    • Management to know location of operative throughout the day
    • Contact office on arrival (with estimate of length of time for task)
    • Regular contact with office with updates if task over 1 hour duration.
    • Final contact with office immediately you leave property.
    • Mobile phone to be available at all times and fully charged
    • Prior assessment of risk of violence / aggression (see above)
    • Team working in higher risk areas (ie in lofts)

  • At least one other person available

  • Frequent contact with management throughout the work period

  • Risk Rating With Control measures

  • Hazard - Children in premises
    Who's at risk - Children
    Risk level - Med

  • Control measures

    • Operatives to request that parents/guardians keep children away from site and site work
    • Ring management for advice if parents not co-operative
    • Clear up at the end of each shift
    • Do not leave tools / equipment etc in a place accessible to children
    • Close front door / gates etc to ensure children do not wander from premises

  • Instructions given to parents/ guardians

  • Work undertaken when children not present

  • Work in secure area ie doors closed

  • Risk Rating With Control measures

  • Hazard - Pets / Animals in premises or in vicinity
    Who's at risk - Operatives
    Risk level - Med

  • Control measures

    • Operatives to request that tenants keep pets / animals in a secure place away from site and site work
    • Ring management for advice if tenants not co-operative
    • Do not approach animals when there is a risk of being attacked
    • If in doubt, leave or do not enter premises
    • In event of a dog / animal bite arrange for medical assistance and tetanus injection

  • Pets / animals kept in secure place

  • Work in secure area ie doors closed

  • Risk Rating With Control measures

  • Hazard - Access Problems
    Who's at risk - Operatives
    Risk level - Med

  • Control measures

    • Management to plan work and pre-arrange visit
    • Management to request good and free access to work areas
    • Operatives to request that tenants move equipment, furniture etc and tidy up areas as required to enable safe access to work areas
    • If necessary, and as a last resort, operatives to move furniture etc before starting work
    • Ring management for advice if tenants not co-operative
    • Good housekeeping by operatives
    • Bring materials onto site as required rather than store materials in the site

  • Client to arrange for removal / movement of equipment, vegetation, waste materials etc

  • Operatives to move furniture / equipment / clutter if tenant not co-operative and as a last resort

  • Tenant to move furniture / equipment / clutter etc and ensure clean work area before work starts

  • Risk Rating With Control measures

Gas certificate onsite

  • CP12

  • Benchmark

Inspection photos

  • Gas meter

  • Water stopcock

  • Cupboard containing immersion tank. Either showing removed or existing depending on heating type.

  • Boiler

General reminders

  • All electrical equipment (inc. chargers) PAT tested
    Tools & equipment in good condition
    All tools stored safely when not in use
    RCD in use/good condition
    Test meters/gas analyser calibrated and in date
    All extension cables in good order
    Safe use of tools & equipment observed
    Earth continuity leads available
    Vehicle parked safely/safe access/egress
    Signage & barriers displayed/closed
    RAMS available
    Valid Gas Safe card produced
    DRA started/completed
    Customer briefed on work and risks
    Safe isolation of gas & electricity
    Good housekeeping (slips, trips, falls)
    Dust sheets/Roll and Stroll used
    Adequate lighting (loft or cramped work)
    Manual handling training received
    Safe lifting techniques observed
    Lifting aids used
    Walk-boards used in loft space
    Personal Protective Equipment (PPE)
    Carried out using safe methods
    Heat Mat/Cool Gel/Water Spray used
    Fire extinguisher in each working area & at front door
    Safety footwear worn and in good condition
    Gloves in good condition and worn
    Hard hat/bump cap worn (inc. chin strap)
    Face masks in good condition and available
    Hi Viz vest/jacket worn and available
    Safety glasses in good condition and worn
    Hearing protection available and worn
    Disposable nonslip over shoes available
    Harness worn (if required) and in good condition (Inspected in the last 12 months)
    Copy of Water Carriers License available
    Waste stored securely
    Spill Kit available (if applicable to work)
    Asbestos Awareness training received
    Vehicle secure
    First Aid Kit inc. eyewash available
    Housekeeping (storage - cab and back)
    Any damage to vehicle
    Tyres in good condition
    Data security observed
    Ladders stored securely
    Any actions raised must be rectified within 28 days.
    Ladder ID visible and in good condition
    Ladder accessories in good condition
    Safe working at height methods observed (TETRA)
    Scaffold structure erected correctly
    Edge protection suitable & sufficient
    Scaffold tag or certificate complete

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.