• To complete this check you will need the last Annual Assessment Form or PIMSS information if it has been confirmed no ACM'S are present put No and sign the new Annual Assessment off.

Location 1

  • In this location are there any ACM'S identified on the last inspection or information on the PIMSS system?

  • UPRN Number if applicable

  • Location and Description

  • Has there been a change in the use of the room?

  • Is there any evidence of physical damage?

  • Is there evidence of water damage?

  • Is there evidence of deterioration?

  • Is the ACM easily accessible?

  • Does a high level of activity take place near the ACM?

  • Is there air-conditioning within the area the ACM is located?

  • Are there any further observations?

  • Further Action or comments:

  • Details for any actions needed or jobs raised to the CSC or Responsible person:

  • Add media

Location 2

  • In this location are there any ACM'S identified on the last inspection or information on the PIMM's system?

  • UPRN Number if applicable

  • Location and Description

  • Has there been a change in the use of the room?

  • Is there any evidence of physical damage?

  • Is there evidence of water damage?

  • Is there evidence of deterioration?

  • Is the ACM easily accessible?

  • Does a high level of activity take place near the ACM?

  • Is there air-conditioning within the area the ACM is located?

  • Are there any further observations?

  • Further Action or comments:

  • Details for any actions needed or jobs raised to the CSC or Responsible person:

  • Add media

Location 3

  • In this location are there any ACM'S identified on the last inspection or information on the PIMM's system?

  • UPRN Number if applicable

  • Location and Description

  • Has there been a change in the use of the room?

  • Is there any evidence of physical damage?

  • Is there evidence of water damage?

  • Is there evidence of deterioration?

  • Is the ACM easily accessible?

  • Does a high level of activity take place near the ACM?

  • Is there air-conditioning within the area the ACM is located?

  • Are there any further observations?

  • Further Action or comments:

  • Details for any actions needed or jobs raised to the CSC or Responsible person:

  • Add media

Location 4

  • In this location are there any ACM'S identified on the last inspection or information on the PIMM's system?

  • UPRN Number if applicable

  • Location and Description

  • Has there been a change in the use of the room?

  • Is there any evidence of physical damage?

  • Is there evidence of water damage?

  • Is there evidence of deterioration?

  • Is the ACM easily accessible?

  • Does a high level of activity take place near the ACM?

  • Is there air-conditioning within the area the ACM is located?

  • Are there any further observations?

  • Further Action or comments:

  • Details for any actions needed or jobs raised to the CSC or Responsible person:

  • Add media

Location 5

  • In this location are there any ACM'S identified on the last inspection or information on the PIMM's system?

  • UPRN Number if applicable

  • Location and Description

  • Has there been a change in the use of the room?

  • Is there any evidence of physical damage?

  • Is there evidence of water damage?

  • Is there evidence of deterioration?

  • Is the ACM easily accessible?

  • Does a high level of activity take place near the ACM?

  • Is there air-conditioning within the area the ACM is located?

  • Are there any further observations?

  • Further Action or comments:

  • Details for any actions needed or jobs raised to the CSC or Responsible person:

  • Add media

Location 6

  • In this location are there any ACM'S identified on the last inspection or information on the PIMM's system?

  • UPRN Number if applicable

  • Location and Description

  • Has there been a change in the use of the room?

  • Is there any evidence of physical damage?

  • Is there evidence of water damage?

  • Is there evidence of deterioration?

  • Is the ACM easily accessible?

  • Does a high level of activity take place near the ACM?

  • Is there air-conditioning within the area the ACM is located?

  • Are there any further observations?

  • Further Action or comments:

  • Details for any actions needed or jobs raised to the CSC or Responsible person:

  • Add media

Location 7

  • In this location are there any ACM'S identified on the last inspection or information on the PIMM's system?

  • UPRN Number if applicable

  • Location and Description

  • Has there been a change in the use of the room?

  • Is there any evidence of physical damage?

  • Is there evidence of water damage?

  • Is there evidence of deterioration?

  • Is the ACM easily accessible?

  • Does a high level of activity take place near the ACM?

  • Is there air-conditioning within the area the ACM is located?

  • Are there any further observations?

  • Further Action or comments:

  • Details for any actions needed or jobs raised to the CSC or Responsible person:

  • Add media

Action plan

  • All outstanding items should be recorded and escalated to the Responsible Person or Line Manager to be addressed.

    Any new issues should be recorded and dealt with as appropriate. Once completed the review form should be revisited and signed off as complete.

  • Please identify outstanding items from previous action plan. Include timescales/priorities and the person responsible (Asset Management, Homes Management, other)

  • Please upload photos if required

  • Identify further work/action required. Including timescale/priority and person responsible (Asset Management, Homes Management, other)

  • Please upload photos if required

Signatures

  • Health & Safety Auditors signature

  • Add signature

  • Select date

  • Clients signature

  • Add signature

  • Select date

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