Title Page
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Conducted on
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Assessor
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Customer reference number
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Address Location
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Customer Name
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Customer Telephone
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Customer Email
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Expected duration of works in days
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Select site
Question Set
Property Details
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Property Type
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Property Type
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Year Built
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Number of bedrooms
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Tenure Type
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Parking
Scaffolding:
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Is the scaffold location detailed on the site plan?
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Are the scaffold dimensions detailed on the site plan?
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Are the scaffold bases detailed on the site plan?
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Have photographs of the proposed scaffold area been taken?
Site Specific Risk Assessment
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Is there any damage to the property or issues with its condition that may present a risk?
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If yes, please give details:
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Take photos
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Are there any issues with the installation work area that may present a risk?
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If yes, please give details:
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Take photos
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Will there be any issues with noise that may present a risk or create a nuisance?
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If yes, please give details:
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Will there be any issues with dust or other airborne materials that may present risk or nuisance?
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If yes, please give details:
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Are there any special customer requirements that should be considered in the risk assessment?
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If yes, please give details:
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Are there any access issues that may present risk or nuisance?
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If yes, please give details:
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Are there any other risks relating to internal works not covered in the Generic Risk Assessment that require addressing?
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If yes, please give details:
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Take photos to show additional risks
PAS 2019 Measure whole dwelling Question Set: (this section must be completed for compliance with PAS 2019):
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Is there a risk of potential moisture build-up as a result of the proposed installation?
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If yes, provide details below:
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Will the proposed installation compromise the fire safety of the dwelling?
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If yes, provide details below:
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Is there evidence of a protected species in or around the dwelling? (e.g. bats, birds, butterflies, dormice or plants
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If yes, provide details below:
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Take pictures to evidence
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Is there any pre-existing damage to the areas that will be accessed by the operatives (all measures)?
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If yes, provide details below:
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Take pictures to evidence
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Will the proposed installation (s) be non-compliant with any requirements stated by the designer / specifier?
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If yes, provide details below:
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Take pictures to evidence
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Will the proposed installation (s) result in the unsafe operation of combustion appliances?
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If yes, provide details below:
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Take pictures to evidence
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Will the site layout or conditions impair the execution of the works in relation to appropriate access to the property and to the elements to be insulated?
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If yes, provide details below:
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Will the site layout or conditions impair the execution of the works in relation to appropriate access to the property and to the elements to be insulated?
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If yes, provide details below:
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Have relevant checks been taken to determine if asbestos-containing materials are present?
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If no, please provide these details below:
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Photos of suspected asbestos
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Are there visible signs of water penetration?
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If yes, provide details below:
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Photos of water penetration areas
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Are there are visible signs of leakage from water system components e.g. pipework?
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If yes, please provide details below:
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Photos of leakages
Notes, drawings additional photos
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Notes
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Additional Photos
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Drwaing Section - Either annotate grid or upload picture of drawings
Surveyor’s Name (Printed):
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Surveyor’s Declaration – To confirm that the survey has been completed in compliance with the requirements of PAS 2030:2019, Building Regulations and any additional requirements stated by the manufacturer(s) of material(s) used.
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Surveyor’s Signature:
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Date:
