SERVE ON BUILDING ASSESSMENT AND SEARCH FORM

• Document No.

• Conducted on

  Date

• Tasked by

• Prepared by

• Location
  Address

• Current mode

  Select Assessment Surface search Intrusive search

  • Assessment
  • Surface search
  • Intrusive search

• Personnel on site

• Location of emergency evac point onsite

List hazards that are present

• Slips,trips and falls

• Utilities

• Confined space

• Use of tools and power tools

• Unsafe and collapsed structures, falling objects

• Manual handing

• Biohazard's

• Fall from height

• Flying debris, Dust

• Crush

• Water, drowning

• Animals

• Moving vehicles, plant machinery

• Stored energy

• Security, local population

• Chemical hazards

• Broken glass, sharp objects

• Fire

• List any other hazards not in above list

• PPE

• Barrier tape, cordens

• Briefings

• Security measures

• Training

• Propping and shoring

• Team rotation

• Fire extinguishers

• Swah

• Alarm system, warning device

• Air filtration, Dust extraction

• Lighting

• Medical

• List comms availiable on site

• List any other control measures below

• What is building used for

  Select Domestic Commercial

  • Domestic
  • Commercial

• What is construction materials

  Select concrete reinforced concrete steel structure brick wood mud, clay

  • concrete
  • reinforced concrete
  • steel structure
  • brick
  • wood
  • mud, clay

• How many floors

• Photographs of building and surrounding area

  Media

• Brief building description

• Enter amount of missing people if known

• All info available on missing and who from

• 

• List building triage status from above flow chart

  Select A B C D E F G H

  • A
  • B
  • C
  • D
  • E
  • F
  • G
  • H

• Draw building and sectors and floors

  Drawing

• Is there further work req on this site

  Yes

  No

  N/A

• Enter task and work details below

• Complete

• Enter task and work details below

• Complete

• Enter task and work details below

• Complete

• Enter task and work details below

• Complete

• Is building marking to required stage

  Yes

  No

  N/A

• Are all taskings and evacuations complete on this building

  Yes

  No

  N/A

• Is there any remaining deceased to be extracted, if so are authorities aware

  Yes

  No

  N/A

• Give brief overview of all work carried out

• Signature

  Sign