Information
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Location of RIsk Assment
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Conducted on start date
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Expected completion date
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Prepared by
This form must be completed prior to work commencing form must be sent to contract delivery manager
Identify hazards associated with works to be undertaken please mark potential hazards
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Electrics Please provide socket and see reading
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Stop all works contact CDM straight away the system is unsafe to continue and a competent electrician needs to rectify before any work continues
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Hot works
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Can this work be be completed without using a hot working process especially in risk zones, can pipe be fabricated, route altered or can alternative methods of jointing ie compression?
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Has assessment of the area where the work is to be carried out been completed?
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Have all combustible materials in close proximity of hot works area been moved ?
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Have you checked all equipment to be used for hot working prior to commencing work ?
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Have materials / structure in close proximity been protected with fire blanket and heat mats ?
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Is there a suitable fire extinguisher in the working area ?
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Have escape routes been identified from the working area in case of emergency ?
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Have the checked the number of persons in the property and advised them of hot works being carried out in the property ?
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Are standard hot works related boards and notices in place throughout the property ?
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Is there any fire detection equipment in the area of hot works if so will it be affected by hot works ?
If you answered no to the above or you feel there is still a risk call contracts manager DO NOT CONTINUE If you are happy there is no risk carry out hot works Be sure to check work area after work. Up to 1 hour and remain on site for a minimum of 1 hour after any hot works.
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Asbestos
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Can work be completed any other way without the disturbance of any asbestos
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Has assessment of the area where work to be carried out been completed?
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Has the asbestos register been read to identify areas of risk ?
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Are you aware of and do you understand the asbestos procedures
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Do you agree to work with in these procedures
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Contact Contract Delivery Manager DO NOT COMMENCE WITH WORK
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Cutting / Grinding <br>
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Dust
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Lifting /carrying
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Access,cellar,loft,
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Handling waste
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Use of ladder/ step ladder / hop up
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Roof work
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Loose carpets
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Earthing /wiring issues
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If you are not electrically qualified and you believe you have a potential risk call Contracts Delivery Manager before starting any work .
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Unsafe structure
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Scaffold work
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Check suitable scaffold tag, carry out inspections if you are not happy call Contracts delivery manager straight away.
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Weather
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Any other issues
From hazards identified above please identify from list below controls you will put in place to remove hazard or reduce risk
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Ear muffs plugs
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Eye protection
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Safety helmet /bump cap
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Face mask P3
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Gloves
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Hi vis clothing
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Safety footwear
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Fire extinguishers
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Heat mats cool gels
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Harness / lanyard
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Lifting straps
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Ladder anti slip mat
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Ladder stand off bracket
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RCD
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Call in help to remove hazard asbestos removal ,electrician, 2nd man or CDM assistance please indicate in box below i
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If assistance required call contracts delivery manager straight away before starting any work
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A frames barrier tape rigid barriers
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Additional lighting
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Sack barrow
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Loft boarding
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Any other actions please record in box below
Areas of concern which could create a potential hazard
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Elderly vulnerable
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Disabled
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Pets or small children
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Confrontation
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Property Congested with furniture
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Poor hygiene
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Any other areas of concern please put in box below
Please identify controls required to prevent hazards from list below
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Walk the job prior to start with customer identifying concerns and job plan
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Dust sheets
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Warning signage
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Stair rods
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Door Barriers
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Ask that dogs are shut in a safe area
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Create a safe area away from works for customer and family
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Any other precautions please record in box below
Existing System details
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Is the existing system in working order
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Record incoming mains pressure
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Record current hot water flow rate
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Have any existing leaks been identified
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Are all electrical controls in working order, time clock Room thermostat.
All operatives on site to name and sign before work commences
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Installer 1 signature
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Installer 2 signature
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Electricians signature
Customer/Engineer completion form
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Have you installed the boiler in line with the manufactures instructions
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Have you cleansed and hot flushed the system and added inhibitor
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If vertical flue is it adequately supported
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Has part L been achieved
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Is all pipe work sleeved and made good thought walls?
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Is the ventilation provision adequate?
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Is MEB present to both gas and water?
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Has all electrical work been carried out to IEE 17th edition regulations
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Is the condense installed and terminated correctly?
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Is all pipe work adequately clipped and joints clean of flux?
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Is the room stat and time clock installed in acceptable position?
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Have all the required labels been attached and is the meter installation up to standard?
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Has all the building works been finished to a acceptable standard?
Paperwork
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Has a CP 1 been completed and a copy left with the customer
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Take photographic evidence
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Has the boiler bench mark been completed?
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Take photograph
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Have you registered the boiler warranty on line
Customer Satisfaction
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Did the engineer call you before the installation date to confirm appointment?
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Did the engineer turn up at the agreed time?
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Did the engineers present their ID cards on arrival?
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Did the engineers advise you of any potential hazards identified in the H&S 2 min hazard warning workout?
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Was your property adequately protected before work started?
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Did the engineer use dust sheets?
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Has all rubbish been removed from the property ready for collection?
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Has the operating instructions been explained to you?
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Has a copy of the operating instruction been left with you?
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Has the engineer talked you through the the PH Jones Customer Satisfaction Survey?
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Have you been given a copy of your warranty paperwork
Comments
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Add any additional comments as required, from customer and installer and sign below to confirm that you are happy with the works carried out by PH Jones.
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Customer signature
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Installer signature