Places for People Annual Assessment Form Reassessment of ACM's v3

• Please state: "UPRN_ACM Review_date

• Address

• Building Name

• Inspection date

  Date

• Assessor

• 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?

  Yes

  No

• UPRN Number if applicable

• Location and Description

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

  Yes

  No

• Is there any evidence of physical damage?

  Yes

  No

• Is there evidence of water damage?

  Yes

  No

• Is there evidence of deterioration?

  Yes

  No

• Is the ACM easily accessible?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• Are there any further observations?

  Yes

  No

• Further Action or comments:

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

• Add media

  Media

Location 2

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

  Yes

  No

• UPRN Number if applicable

• Location and Description

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

  Yes

  No

• Is there any evidence of physical damage?

  Yes

  No

• Is there evidence of water damage?

  Yes

  No

• Is there evidence of deterioration?

  Yes

  No

• Is the ACM easily accessible?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• Are there any further observations?

  Yes

  No

• Further Action or comments:

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

• Add media

  Media

Location 3

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

  Yes

  No

• UPRN Number if applicable

• Location and Description

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

  Yes

  No

• Is there any evidence of physical damage?

  Yes

  No

• Is there evidence of water damage?

  Yes

  No

• Is there evidence of deterioration?

  Yes

  No

• Is the ACM easily accessible?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• Are there any further observations?

  Yes

  No

• Further Action or comments:

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

• Add media

  Media

Location 4

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

  Yes

  No

• UPRN Number if applicable

• Location and Description

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

  Yes

  No

• Is there any evidence of physical damage?

  Yes

  No

• Is there evidence of water damage?

  Yes

  No

• Is there evidence of deterioration?

  Yes

  No

• Is the ACM easily accessible?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• Are there any further observations?

  Yes

  No

• Further Action or comments:

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

• Add media

  Media

Location 5

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

  Yes

  No

• UPRN Number if applicable

• Location and Description

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

  Yes

  No

• Is there any evidence of physical damage?

  Yes

  No

• Is there evidence of water damage?

  Yes

  No

• Is there evidence of deterioration?

  Yes

  No

• Is the ACM easily accessible?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• Are there any further observations?

  Yes

  No

• Further Action or comments:

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

• Add media

  Media

Location 6

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

  Yes

  No

• UPRN Number if applicable

• Location and Description

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

  Yes

  No

• Is there any evidence of physical damage?

  Yes

  No

• Is there evidence of water damage?

  Yes

  No

• Is there evidence of deterioration?

  Yes

  No

• Is the ACM easily accessible?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• Are there any further observations?

  Yes

  No

• Further Action or comments:

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

• Add media

  Media

Location 7

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

  Yes

  No

• UPRN Number if applicable

• Location and Description

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

  Yes

  No

• Is there any evidence of physical damage?

  Yes

  No

• Is there evidence of water damage?

  Yes

  No

• Is there evidence of deterioration?

  Yes

  No

• Is the ACM easily accessible?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• Are there any further observations?

  Yes

  No

• Further Action or comments:

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

• Add media

  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

  Media

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

• Please upload photos if required

  Media

Signatures

• Health & Safety Auditors signature

• Add signature

  Sign

• Select date

  Date

• Clients signature

• Add signature

  Sign

• Select date

  Date