Title Page
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Date:
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Address:
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Client:
Instructions
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This survey must be completed to doucment any higher risk working at height activites that will be carried out by MD employees i.e. working involving working fixed scaffolding, larger scale roofing works, chimney works, using power tools whilst working at height etc. Theses works may need additional documenation, control measures and sign off, i.e. larger scale roofing works, using higher voltage power tools whilst working at height etc.
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It is your responsibility to ensure any employee(s) that are scheduled to undertake this high risk work have relevant and in date training.
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You must ensure a task specific risks assessment (QMF 483) is completed and avaliable to all relevant persons, if MD generic risk asssessments do not cover this particular task.
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If you have any concerns please raise with relevant Compliance team or SHEQ
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Health and Safety: SHEQ@mdgroup.co.uk
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Gas: Geoffrey.talbot@mdgroup.co.uk
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Electrical: Compliance@mdgroup.co.uk
Checklist
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Give brief description of planned works:
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Job Number:
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Property Type
- Bungalow
- Detached
- Semi-detached
- End of Terrace
- Mid Terrace
- Maisonette
- Cottage
- Block of flats
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How many storeys?
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What type of access equipment will be used?
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Please give details
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Will planned works be intrusive?
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Do you have a copy of the relevant asbestos report(s)?
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No intrusive works can take place without having the necessary asbestos information - you MUST obtain a copy of the asbestos report and ensure it is made avaliable to all relevant parties before works commence.
Roofing works
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Roofline?
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Will the works take place to overhead unshealthed power cables?
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You must speak to your Line Manager for further advise, which may include engaging with the DNO.
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Existing Tile Type
- Natural Slates
- Machine Made Slates/Concrete
- Plain Tiles
- Interlocking Tiles
- 3 Layer High Performance Felt
- Other
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Please detail
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Access to Rear Elevation?
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Please list any restrictions or issues i.e. garage, lean to, flat roof
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Does the chimney need to be removed as part of works?
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Have you recieved necessary paperwork / notification from the Client the chimney is no longer in use?
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Is the chimney made of unusual construction i.e. reinforced prefabricated concrete
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You must ensure a site specific risk assessment is completed and submitted to your Operations Manager for sign off before works begin.
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Will the planned works be taking place close to flues?
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You must ensure the Operatives working around the flues have sat the Gas Safety TBT within the last 6 months.
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Are flues caged?
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Does any flue need to be capped before works commence?
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You must use a qualified Gas Safe engineer to carry out relvent Gas works, testing and inspection. Please reference QMF 26 SHEQ Contractor & Supplier Tracker on the SHEQ drive to see a list of approved Gas Contractors.
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List any other concerns:
Loft space
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A survey of the loft space should be carried out to photograph existing pipe / flues, and check if there are any signs of bats. If you do find any evidence of bats please escalate to your Operations Manager immediately.
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Please take photos of Flues / pipes
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Add relevant photos & comments
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Add relevant photos & comments
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Add relevant photos & comments
Signed
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Do you believe there are necessary control measures and all relevent information avaliable for the works to commence?
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Details reasons why:
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Ensure Oneserve is updated and all relevant personnel are informed the job is on hold until necessary control measures are in place.
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Name of person completing survey:
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Job Title:
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Signature:
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Date:
