MDU Escalation V1.0

• Conducted on

  Date

• Prepared by

Risk Assessment

• What external hazards have you identified?

  Select Strong Winds Traffic/Parking Uneven Ground Decking Gas/Electric Garden Animal/Pets Ice/Snow/Wet Third Parties Manual Handling Scaffolding Hazardous Substance Falling Light Garden None

  • Strong Winds
  • Traffic/Parking
  • Uneven Ground
  • Decking
  • Gas/Electric
  • Garden
  • Animal/Pets
  • Ice/Snow/Wet
  • Third Parties
  • Manual Handling
  • Scaffolding
  • Hazardous Substance
  • Falling Light
  • Garden
  • None

• Are the hazards controllable? If no then escalate.

  Select Yes No

  • Yes
  • No

• What internal hazards have you identified?

  Select Furniture Stairs Animals/Pets Non Carpeted Floor Stairs Gas/Electric Third Parties Manual Handling Hazardous Substance Items In Riser Cupboard Loft Hatch Third Party Equipment

  • Furniture
  • Stairs
  • Animals/Pets
  • Non Carpeted Floor
  • Stairs
  • Gas/Electric
  • Third Parties
  • Manual Handling
  • Hazardous Substance
  • Items In Riser Cupboard
  • Loft Hatch
  • Third Party Equipment

• Are the hazards controllable? If no then escalate

  Select Yes No

  • Yes
  • No

• Is a ladder required to continue and complete the visit? If yes can our Safe System of Work be followed? If no then you must follow the escalation process.

  Select No Combi-Ladder A-Frame Combi-Ladder Single Section Single Section Double Section Triple Section CAT Ladder

  • No
  • Combi-Ladder A-Frame
  • Combi-Ladder Single Section
  • Single Section
  • Double Section
  • Triple Section
  • CAT Ladder

• If you are accessing the loft how will you gain entry?

  Select Combi-Ladder Single Section Fitted Ladder Pull Down Ladder

  • Combi-Ladder Single Section
  • Fitted Ladder
  • Pull Down Ladder

• Confirm use of PPE.

  Select Yes No

  • Yes
  • No

• Where is the head-end you will be working on, please give a brief description?

Visit Details

• Visit Type

  Select Post Visit On-Site Engineer Visit Escalated Visit

  • Post Visit
  • On-Site Engineer Visit
  • Escalated Visit

• Previous Job Number

• Address
  Address

• Engineer

• Date Of Engineer Visit

  Date

Entry Checks

• Earthed

• Space

• Signal

• Power

Escalation

• Please give a brief description why the job has been escalated? Include any relevant photos below.

• Add media

  Media

• What has been done to resolve the escalation? Include relevant photos below.

• Add media

  Media

• Was additional support required from Sky Homes?

• Who was your point of contact at Sky Homes?

• Does the job need to be referred back to the MA?

• Capture any details why the job requires to be referred back to the MA? (If Applicable)

• CAI Dangerous Situation Form Issued (If Applicable)

Additional Information

• Capture any extra relevant information from todays visit.

Exit Checks

• Text Taps

• Text Taps Reference Number

• Add signature

  Sign