Title Page

  • © J Luscombe Associates Limited 2021.
    All rights reserved.

  • Survey for:

  • Survey Location:

  • Rainbow International Ref:

  • Prepared by:

  • Date:

Instruction Overview

Instruction Overview

  • Instruction Date

  • Instructing Party

  • Contact Name and Contact Number

  • Insurance Company

  • Instruction Description

  • Instruction Background

  • Visit Date & Time

  • Engineer(s)

  • Engineer's Visual Report

  • External Photo of Property

Risk Assessment

  • ASBESTOS

  • Controls - STOP If in doubt assume it is an ACM. DO NOT DISTURB the material unless qualified & exercising control measures. Sample & make safe by encapsulation or exclusion. Wear PPE & RPE. Record all steps taken & photograph.

  • MANUAL HANDLING

  • Controls - Do not lift unnecessarily. Use lift equipment whenever possible. Get trained help if appropriate.

  • SLIPS, TRIPS & FALLS

  • Controls - Tape down all pipes & cables. Use the shortest run & cover if possible. Photograph your measures. Position equipment safely.

  • EXPLOSION

  • Controls - Map gas runs before excavation. Note in your methodology. Isolate gas/LPG/Heating Oil supply before excavation. No naked flames or smoking.

  • HEIGHTS

  • Controls - No heights work without certification by IPAF or height/ladder training. Excavations to be taped off

  • ELECTROCUTION

  • Controls - Be cable-aware at all times. Check for RCD protection before starting excavation. Use current detector before invasive works. Wear gloves. Check for electric underfloor heading.

  • DISEASE

  • Controls - Stay COVID19 aware. Wear PPE & be mindful of both animal & plant potential infections. Use anti microbial cleaners. If in doubt STOP & seek advice.

  • LONE WORKING

  • Controls - Does someone know where you are? Arrange regular contact & “contact lost” procedure. Do not put yourself at risk.

  • I have carried out a risk assessment & informed others whom it may affect:

Primary Checks

    Manifestation
  • Location

  • Description

  • Evidence

  • Have any systems or zones been isolated?
  • Is this temporary or permanent

  • Will opening the isolation effect loss rate or aid diagnosis?

  • Notes

  • External Inspection
  • Notes

  • Excessive output from boiler (condensation pipe/pressure relief valve)

  • Notes

  • Evidence

  • Exterior of property showing signs of damp

  • Notes

  • Evidence

  • Are any overflows from toilets or heater tanks wet or showing signs of dripping

  • Notes

  • Evidence

  • Gutter, downpipe or drain issue

  • Notes

  • Evidence

  • Any causes of damp bridging

  • Notes

  • Evidence

  • Any structural faults leading to water ingress (e.g. cracked render, poor pointing, roof/valley issues)

  • Notes

  • Evidence

  • Signs of excessive ground water or aquafer

  • Notes

  • Evidence

  • Boundary box and stopcock(s)
  • Notes

  • Internal stopcock located?

  • Stopcock functioning correctly?

  • Photo of internal stopcock

  • Boundary box located?

  • Stopcock functioning correctly?

  • Meter present or temporary meter fitted

  • Meter movement videoed with internal stopcock open?

  • Water consumption detected?

  • Water consumption quantity over time period?

  • Meter movement videoed with internal stopcock closed?

  • Water consumption detected?

  • Water consumption quantity or time period?

  • No consumption with internal stopcock both open and closed indicates NO LEAK from mains fed systems

  • Consumption with internal stopcock closed indicates external leak

  • Consumption with internal stopcock open and no consumption with internal stopcock closed indicates internal leak

  • Consumption with internal stopcock both open and closed indicates internal AND external leak

  • Boundary box test indicates

  • Notes

  • Has boundary box been worked on recently

  • Notes

  • Evidence

  • Is there excessive water in the boundary box

  • Investigate possible leaking coupling. May require utility company repair.

  • Notes

  • Evidence

  • Summary Notes

  • Boiler survey
  • Location

  • Notes

  • Photo of boiler

  • Boiler make and model

  • Boiler fired by

  • Boiler approx. age

  • Boiler last serviced date

  • Boiler notes

  • Boiler type

  • Header tank dripping

  • Consider sealing the system, pressuring & doing an acoustic survey

  • Is water loss consistent with volume of leakage?

  • Notes

  • Evidence

  • Is the filling loop dry & working correctly

  • Notes

  • Evidence

  • Excess water from condensation pipe

  • Volume of water from condensation pipe over time period

  • Evidence

  • All pipework around the boiler dry

  • Notes

  • Evidence

  • Tundish dry

  • Notes

  • Evidence

  • Central Heating System
  • Central Heating comments

  • System type

  • System losing pressure

  • Volume of loss & notes

  • Check for acoustic anomalies

  • Consider sealing the system, pressuring & doing an acoustic survey

  • All radiators working properly

  • Why? Is this relevant?

  • Notes

  • Possibility of redundant pipes from moved/removed radiators (e.g. under kitchen units or for modelling)

  • Notes

  • Ask customer if property has been modified or extended or radiator(s) moved or removed.

  • All radiators dry

  • Can leaks be stopped? Is water loss consistent with volume of leakage?

  • Notes

  • Evidence

  • Any signs of damp around the radiators

  • Source of damp visible? Is water loss consistent with volume of leakage?

  • Notes

  • Evidence

  • Does the property have underfloor heating

  • Is the manifold dry and in order

  • Notes

  • Evidence

  • Are the manifold outflows balanced

  • Notes

  • Evidence

  • Any sign of discoloured flooring or moisture damage to the floor

  • Notes

  • Evidence

  • Hot and cold supply (internal)
  • Notes

  • All joints and pipework dry

  • Consider sealing the system, pressuring & doing an acoustic survey

  • Is water loss consistent with volume of leakage?

  • Notes

  • Possible redundant pipework

  • Ask customer has the property been modified or extended - especially bathrooms, toilets, utility rooms or kitchens. Think pipework & rads

  • Notes

  • Evidence

  • Appliances
  • Notes

  • Supply to white goods dry

  • Notes

  • Evidence

  • All toilet cisterns shutting off

  • Notes

  • Evidence

  • Showers/Baths
  • Location

  • Notes

  • Shower/Bath trap in order

  • Notes

  • Evidence

  • Shower/Bath base in order

  • Notes

  • Evidence

  • Grout/mastic in order

  • Notes

  • Evidence

  • Enclosure in order

  • Notes

  • Evidence

  • Shower/Bath fittings in order

  • Notes

  • Evidence

  • Taps/Regulator and hidden pipework in order

  • Notes

  • Evidence

  • Wastes
  • Notes

  • All accessible joints and connections dry

  • Notes

  • Evidence

  • Salts Test
  • Location

  • Notes

  • Nitrates (Red/Brown Result)

  • Ground water/rising damp

  • Notes

  • Evidence

  • Chlorides (Yellow Result)

  • Treated water from a system

  • Notes

  • Evidence

  • Inconclusive (Yellow/Red Results)

  • Possibly rain water

  • Notes

  • Evidence

  • Dye Test
  • Dye test carried out on waste(s)

  • Notes

  • Evidence

  • Other Potential Causes
  • Has there been a previous escape of water or flood at the property

  • Has the property been dried properly

  • Notes

  • Evidence

  • Is there an issue with an adjoining property

  • Notes

  • Evidence

  • Is DPM and DPC in order

  • Notes

  • Evidence

  • Signs of Bridging or Penetrating Damp

  • Notes

  • Evidence

  • Is condensation an issue

  • Notes

  • Evidence

  • Ventilation under ground floor in order

  • Notes

  • Evidence

  • Capped chimney

  • Is there adequate ventilation

  • Consider endoscope survey

  • Notes

  • Evidence

Secondary Checks

    Moisture Mapping
  • Location

  • Excessive moisture discovered

  • Excessive Moisture Area
  • Notes

  • WME/MC reading(s)

  • Evidence

  • Infrared Camera Survey
  • 1)Cold taps running slowly 2) Hot taps running slowly boiler highest setting 3) CH on highest setting 4) Boiling water in wastes

  • Notes

  • Infrared Camera Survey Anomaly
  • Location

  • Notes

  • Evidence

  • Acoustics Survey
  • Notes

  • Acoustics Survey Anomaly
  • Location

  • Notes

  • Evidence

  • Endoscope Survey
  • Notes

  • Endoscope Survey Anomaly
  • Location

  • Notes

  • Evidence

  • Ferret Survey
  • Notes

  • Location
  • Location

  • Notes

  • Evidence

  • Other Inspection/Survey Works
  • Notes

  • Other Works
  • Notes

  • Evidence

Tracer Gas Survey

    Tracer gas survey
  • System/location

  • Notes

  • System drained down

  • Reason/notes

  • Boiler switched off/isolated

  • BOILER MUST BE SWITCHED OFF/ISOLATED

  • Is the water clear or very discoloured when draining down

  • All radiator bleed valves closed

  • Close all radiator bled valves before introducing gas

  • Notes

  • All radiators fully open

  • Ensure all radiators are fully open before introducing gas

  • Notes

  • All zone/diverter valves manually set to open

  • Manually set all zone/diverter valves open including hot water system.

  • All automatic air bleed valves closed. Check non-vented boiler and CH high points (loft/airing cupboard)

  • Ensure all bleed valves are closed before proceeding. System unlikely to hold pressure.

  • Gas fill point

  • Maximum tracer gas pressure

  • Pressure loss

  • Pressure loss/period

  • Gas detected internally

  • Notes

  • Evidence

  • Gas detect from hot water tap(s)

  • Indicates heating coil in water cylinder has failed

  • Notes

  • Evidence

  • Gas detected externally

  • Notes

  • Evidence

  • Notes

  • System refilled

  • Reason/notes

  • Automatic air bleed valves opened

  • Open all automatic air bleed valves

  • Notes

  • Radiators reset

  • Reason/notes

  • Inhibitor added to system

  • Reason/notes

  • Additional charge may apply

  • Leak sealing agent added

  • Reason/notes

  • Additional charge may apply

Excavation

    Excavation
  • Customer contact advised prior to excavation and agrees to our terms & conditions

  • Reason customer not advised

  • Customer must accept our terms & conditions.
    We will carry out the excavation using best endeavours
    Making-good the excavation is customer’s responsibility

  • A leak might not be found

  • Further excavation works may be necessary

  • We will use best endeavours, however, we may cause collateral damage whilst excavating including striking a water or gas pipe or other service. Any repair or making-good is the responsibility of the customer.

  • As a result of the excavation the customer accepts that some or all utility services maybe disrupted until such time as a repair or other works can be carried out.

  • Does customer contact have plans of pipework and other service routings

  • Customer contact advised we accept no liability for any disruption and/or repair to any utility service we might strike or disrupt or otherwise damage.

  • Reason customer contact not advised

  • Is there NOW or HAS THERE EVER BEEN a gas/LPG/oil supply to the property

  • Has the gas/LPG/oil mains supply been isolated

  • GAS/LPG/OIL SUPPLY MUST BE ISOLATED BEFORE EXCAVATION

  • Notes

  • Location
  • Location of excavation

  • Reasons for excavation

  • Additional notes supporting excavation

  • Is there any wet or electrical underfloor heating in the area of excavation

  • Isolate electrical underfloor heat before proceeding

  • Proceed with extreme care

  • Use pipe detector or IR to detect wet pipework

  • Has the area been scanned for pipes, cables or other obstructions

  • Reason area not scanned (Area should be scanned to avoid risk of death, injury or damage)

  • Before photos

  • After photos

  • Any collateral damage caused

  • Homeowner advised

  • Reason why homeowner not advised

  • Notes

  • Evidence

  • Notes

Conclusion

  • Discussion

  • Conclusion

  • Repair carried out
  • Type of repair

  • Notes

  • Cost to be charged to party instructing works

  • Cost notes

  • Refer to insurers

  • Reason (e.g. Property damage due to Escape of Water and/or requires professional drying to mitigate structural damage)

  • Notes

  • Notes

  • Cost recovery opportunity

  • Notes

Recommendation

  • Recommendation(s)

  • Notes

  • Notes

  • Does the property require professional drying

  • Reason

  • Notes

  • Photos

  • Notes

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.