Information
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Job No.
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Short Address
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Full Address
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Conducted on
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Prepared by
General Information
GENERAL INFORMATION
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Scope of Works
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Work Type
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Enforcing Authority
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Expected Start Date
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Expected Duration of the Works
- 1 day
- 2 days
- 3 days
- 4 days
- 5 days
- +5 days
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Are the Works Subject to CDM Regulations?
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Details of Principal Contractor
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Details of CDM Coordinator
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Are Additional Licence Holders Involved in the Works
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Details of Licence Holder
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Licence No.
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Occupancy Type
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Key Availability Details & Working Time Availability
Asbestos Risk Assessment
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Type of Survey Undertaken
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Survey Carried Out By
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List Work Areas
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Work Area
Drawing
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Asbestos Location (Eg. WC Ccistern, Riser Panel, etc.)
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Add sketch for each work area
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Asbestos Type
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Asbestos Condition
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Approximate Quantity of waste to be removed (Specify number of bags, wraps, skips, etc.)
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Details of waste contractor
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Enter Details of Waste Contractor
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Will Short Term Exposure Limit Be Exceeded?
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Number of People Affected
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Expected Fibre Release
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Duration of Exposure
Control Measures
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Fibre Suppressant Controls
- Hand Held Spray
- Needle Machine
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Additional Controls
PARKING
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Is the Site Within the London Congestion Zone
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Parking Area
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Dispensation Required
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Parking for Loading and Unloading Available
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Parking Available for DCU?
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Is the DCU to be on level ground?
Analytical Information
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Analytical Company
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Insert details of analytical company if known
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Tests Required
- Smoke Test
- 4 Stage Clearance
- Reassurance Test
- Background Test
- Personal Monitor
Equipment
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NPU
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Roving Head
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Class 'H' Vacs
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Transformer
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Wet Vac
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Additional Requirements or Specialist Plant
Hygeine Facilities
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Decontamination Unit
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Bowser
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Self-contained Unit
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Modular Unit
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Water Available
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Ensure water container is filled and available
Emergency Information
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In the event of an operative being left alone they must remain in contact with their supervisor.
In the event of a fire or similar emergency all operatives will muster in accordance with the instructions given to them by the site manager. In the event of no site management being available staff will muster by the company van.
Workplace Risk Assessment
SITE HAZARDS
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Fragile Roof - Probability of Injury
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Potential Severity
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Overhead Services - Probability of Injury
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Potential Severity
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Falling Materials - Probability of Injury
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Potential Severity
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Manual Handling - Probability of Injury
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Potential Severity
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Confined Spaces - Probability of Injury
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Potential Severity
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Buried Services - Probability of Injury
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Potential Severity
WORK AT HEIGHT
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Steps - Probability of Injury
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Potential Severity
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Podium Steps - Probability of Injury
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Potential Severity
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Ladders - Probability of Injury
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Potential Severity
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Roof Ladders - Probability of Injury
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Potential Severity
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Tower Scaffold - Probability of Injury
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Potential Severity
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Fixed Scaffold - Probability of Injury
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Potential Severity
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MEWPS - Probability of Injury
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Potential Severity
HEALTH HAZARDS
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MEWPS - Probability of Injury
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Potential Severity
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COSHH - Probability of Injury
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Potential Severity
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Heat / Cold Stress - Probability of Injury
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Potential Severity
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Weils Desease - Probability of Injury
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Potential Severity
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Legionella - Probability of Injury
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Potential Severity
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Vibration - Probability of Injury
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Potential Severity
Enabling & Reinstatement
Enabling
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It is vital that enabling works are described in as much detail as possible. The information entered here forms the basis if the order sent to the reinstatement team. Please be as accurate as possible. Tick box if reinstatement works required
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Type of work required
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Carpentry
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Sketch
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Plumbing
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Sketch
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Other
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Sketch here if necessary
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Photographs
Reinstatement
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It is vital that reinstatement works are described in as much detail as possible. The information entered here forms the basis if the order sent to the reinstatement team. Please be as accurate as possible. Tick box if reinstatement works required
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Type of work required
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Carpentry
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Sketch
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Plumbing
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Sketch
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Plastering
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Sketch here if necessary
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Decoration
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Sketch here if necessary
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Other
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Sketch here if necessary
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Photographs
Appointment
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To ensure that the appointment date to conveyed to the tenant and they understand the areas to be worked in and the requirement to clear the areas the following should be explained and a resident's signature obtained.
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Agreed date for the works to be carried out
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Time that the works will commence
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Areas to be cleared
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Likely number of operatives on site
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Access restrictions
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Possible damage to decor
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Resident to sign here to acknowledge the above information
