Title Page
-
Policyholder / Client Reference No. / Contractor Reference No.
-
Peril
- Escape of Water 💦
- Flood 💦
- Fire🔥
- Storm 💨
- Accidental Damage🤦♀️
- Impact 🚗💥
- Subsidence 🏡☀️
- Burglary 🚔
- Malicious Damage ⚒
- Escape of Oil ⛽️
- Building Defect 🏚
- Private Works 👷♂️
- Other
-
Front Elevation
-
Conducted On
-
Prepared By
-
Location
-
Client
Details of Property & Cause of Damage
-
Age of Property
- Pre-1900s
- 1900s
- 1910s
- 1920s
- 1930s
- 1940s
- 1950s
- 1960s
- 1970s
- 1980s
- 1990s
- 2000s
- 2010s
-
Is Property Listed or in Heritage / Conservation Area?
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Asbestos Hazard Possible - Check for over-skimmed ceilings and walls, textured coatings, thermoplastic floor tiles and bitumen.
-
Condition of Property
- Good
- Fair
- Poor
- N/A
-
Type of Property
- House
- Bungalow
- Flat
- Garage
- Out-Building
- Shed
- Shop
- Factory Unit
- Warehouse
- Commercial Property
- Industrial Property
-
Building Type
- Detached
- Semi-Detached
- Mid-Terrace
- End-Terrace
- Ground Floor Flat
- 1st Floor Flat
- 2nd Floor Flat
- 3rd Floor Flat
- Other
-
Other Type
-
Roof Material
- Tile
- Slate
- Felt
- Fibreglass
- Eco-Roof
- Other
-
What is Material?
-
Wall Material
- Brick
- Blockwork
- Stone
- Rendered
- Cladding
- Timber
- Other
-
What is Material?
-
Cause of Damage
-
Scope of Works - Brief Outline
-
Is Claim being Repudiated?
-
Please detail why the claim is being Repudiated.
-
Please detail why part of the claim is being Repudiated and under what cover the remainder of the claim is being covered?
Welfare
-
Bathroom or Kitchen Pod Required
-
Detail What & Why?
-
AA Required?
-
Detail Why
-
Parking
- On Road - No Restrictions
- Permit Parking on Road - PH to supply permits
- Permit Parking on Road - Contractor to supply permits
- On Driveway
- In Public Car Park
-
Access Arrangements - Keys & Access
-
Portaloo Required?
-
OK to Use Toilet? 👍
-
OK to Use Power? 👍
-
OK to Use Water? 👍
-
Access to Hot Water? 👍
-
Is a Welfare Unit Required for Workforce?
-
Any Roaming Pets (cats or dogs etc)?
-
Can they be isolated from Workforce & Area of Works?
-
Consider Injury to Workforce or Pet. Consider Pet escaping. Advise PH.
-
Advise PH to keep pets away from Workforce and work area including access.
-
Does Anyone in the Property have any Health Issues?
-
Please detail health issues.
-
Does the PH require AA due to Health Issues? If Yes, please mark on form under AA section.
-
Is Anyone in the Property considered Vulnerable?
-
Please detail concerns.
-
Who Are You Meeting With?
- Mr. Policyholder
- Mrs Policyholder
- Mr & Mrs Policyholder
- Spouse or Partner of Policyholder
- PH’s Son
- PH’s Daughter
- PH’s Friend
- PH’s Neighbour
- PH’s Own Surveyor
- PH’s Own Loss Assessor
- Other
-
Other Party?
-
Has the PH / Representative understood the Scope and what happens next?
-
Room / Elevation / Element
Room / Elevation / Element
-
Add media
-
Is Drying Required?
-
Is an Air Scrubber Required?
-
Any materials requiring testing for Asbestos? ⚠️☠️
- Yes
- No
- Potential ACMs in work area which are not visible or may be disturbed!
-
- Artex Ceiling
- Artex Walls
- Marley Floor Tiles
- Bitumen Adhesive
- Soffit Board
- Asbestos Insulation Board
- Roof Tiles
- Flat Roof
- Water Tank
- Verge Board / Undercloaking
- No Asbestos
- Other
-
Detail location & reason for caution or likely disturbance?
-
Have any materials already been tested for asbestos?
-
Are the results known?
-
What materials have tested positive? ☠️
- Artex Ceiling
- Artex Walls
- Marley Floor Tiles
- Bitumen Adhesive
- Soffit Board
- Asbestos Insulation Board
- Roof Tiles
- Flat Roof
- Water Tank
- Verge Board / Undercloaking
- No Asbestos
- Other
-
Materials Required?
- Wall Tiles
- Floor Tiles
- Laminate Flooring
- Wood Flooring
- Vinyl Flooring
- Wallpaper
-
Wall Tile Area =
-
Floor Tile Area =
-
Laminate Flooring Area =
-
Wood Flooring Area =
-
Vinyl Flooring Area =
-
Wallpaper Rolls / Area =
