Title Page

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

  • Homeowner/Policyholder/Tenant

  • Survey Location

  • Rainbow International Ref

  • Prepared by

  • Date

Instruction Overview

Instruction Overview

  • Instruction Date

  • Instructing Party

  • Notes

  • Insurance Company

  • Notes

  • Insurer's Claim Reference

  • Excess to be collected

  • Excess Amount

  • Excess collected

  • Reason excess not collected

  • Contact Name and Contact Number

  • Instruction Description

  • Instruction Background

  • Visit Date & Time

  • Engineer(s)

  • Engineer's Initial Visual Report - (Kerbside impression and construction of property)

  • 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. Keep a mobile phone with you. Do not put yourself at risk.

  • Other Risks and Controls
  • Risk

  • Control

  • 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 or DPC compromised

  • Notes

  • Evidence

  • Are any overflows from toilets or header 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

  • Check old OS maps on www.oldosmaps.co.uk for old water courses, springs etc.

  • Notes

  • Evidence

  • Boundary box and stopcock(s)
  • Notes

  • Internal stopcock located?

  • Stopcock functioning correctly?

  • Notes

  • Photo of internal stopcock

  • Boundary box located?

  • Stopcock functioning correctly?

  • Notes

  • Photo of external stopcock

  • Meter present or temporary meter fitted

  • Video the meter for at least 5 minutes to calculate leakage volume. Video for less time if loss is excessive.

  • Meter movement observed with internal stopcock open?

  • Water consumption detected?

  • Water consumption quantity over time period? (first red number is 100s of litres next is 10s next is single litres etc.)

  • Video the meter for at least 5 minutes to calculate leakage volume. Video for less time if loss is excessive.

  • Meter movement observed with internal stopcock closed?

  • Water consumption detected?

  • Water consumption quantity or time period? (first red number is 100s of litres next is 10s next is single litres etc.)

  • No consumption with internal stopcock both open and closed indicates NO LEAK from supply fed system(s)

  • Consumption with internal stopcock closed indicates supply pipe leak

  • Consumption with internal stopcock open and no consumption with internal stopcock closed indicates internal leak from supply fed system(s)

  • 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

  • If the works have caused leakage the water company to be advised by homeowner/tenant/landlord

  • Notes

  • Evidence

  • Is there excessive water in the boundary box

  • Investigate possible leaking coupling. Salts test the water for chlorides (processed water). Homeowner/tenant/landlord to arrange water company repair if processed water present.

  • Notes

  • Evidence

  • Summary Notes

  • Carry out internal pressure test using pressure gauge on appliance feed or similar

  • Internal pressure test performed

  • Pressure holding with internal stopcock open

  • Internal or external leakage

  • Notes

  • Evidence

  • Pressure holding with internal stopcock closed

  • Internal leakage

  • Notes

  • Evidence

  • Results of pressure test

  • Notes

  • Evidence

  • Boiler survey
  • Location

  • Notes

  • Photo of boiler

  • Boiler make and model

  • Boiler fired by

  • Notes

  • Evidence

  • Boiler approx. age

  • Boiler last serviced date

  • Boiler notes

  • Boiler type

  • Small Central Heating header tank dripping

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

  • Is water loss consistent with volume of leakage?

  • Notes

  • Evidence

  • Is the filling loop dry & working correctly

  • Notes

  • Evidence

  • Tundish dry

  • 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

  • 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 and/or underfloor heating working properly

  • Why? Is this relevant?

  • Notes

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

  • Notes

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

  • Pipework on all radiators dry. (Do not forget under unit radiators or radiators in strange locations e.g. outside toilets)

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

  • Notes

  • Evidence

  • Any signs of damp around the radiators (e.g. walls/floors discoloured, skirtings blown, grout cracked/damp, hollow tiles)

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

  • Notes

  • Evidence

  • Does the property have underfloor heating

  • Are the manifolds dry and in order

  • Notes

  • Evidence

  • Are the pressures at the manifold balanced

  • Notes

  • Evidence

  • Hot and cold supply (internal)
  • Notes

  • All joints and pipework dry

  • Consider sealing the system, pressurising & doing an acoustic survey if low pressure system (e.g. fed from header tank)

  • Is water loss consistent with volume of leakage?

  • Notes

  • Large header tank dripping

  • Could be hot or cold water system leak. Consider sealing the system, pressurising & doing an acoustic survey

  • Notes

  • Evidence

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

  • Possible redundant pipework

  • Notes

  • Evidence

  • Appliances
  • Notes

  • Supply to all white goods dry

  • Notes

  • Evidence

  • All toilet cisterns shutting off

  • Notes

  • Evidence

  • Sanitaryware (e.g. Showers, Baths, Hand Basins, Bidets, Toilets etc.)
  • Where you have multiple items with issues (e.g. two showers and a bath) add a new Sanitaryware section for each item

  • Location & Sanitaryware Item

  • Notes

  • Sanitaryware traps in order

  • Notes

  • Evidence

  • Sanitaryware base in order

  • Notes

  • Evidence

  • Grouts/mastics in order

  • Notes

  • Evidence

  • Enclosures in order

  • Notes

  • Evidence

  • Sanitaryware fittings in order

  • Notes

  • Evidence

  • Taps/Regulators and hidden pipework in order

  • Notes

  • Evidence

  • Wastes
  • Notes

  • All accessible joints and connections dry

  • Notes

  • Evidence

  • Salts Test
  • Location

  • Notes

  • Nitrates - small pot (Red/Brown Result)

  • Ground water/rising damp

  • Notes

  • Evidence

  • Chlorides - large pot (Yellow Result)

  • Treated water from a system

  • Notes

  • Evidence

  • Inconclusive (Yellow Nitrates/Red Chlorides Result)

  • 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 there an issue with any DPM or DPC

  • Notes

  • Evidence

  • Signs of Bridging or Penetrating Damp

  • Notes

  • Evidence

  • Is condensation an issue

  • Record surface temperatures, absolute humidity in gpk, temperature of the air, time of day, dew point, compass direction of the wall. Is this a ventilation (no trickle vents on windows, extractor fan not working/missing/not running on), life style (drying washing indoors, tumble dryer or boiling lots of foods) or a temperature/time of day issue.

  • Notes

  • Evidence

  • Ventilation under ground floor in order

  • Notes

  • Evidence

  • Capped chimney

  • Is there adequate ventilation

  • Consider endoscope survey

  • Notes

  • Evidence

Secondary Checks

  • Pipework Survey

  • Pipework Survey
  • Use CAT & Genny to scan for pipework. Scan Gas/LPG/Oil , hot & cold supply, central heating (multiple rads and flow/returns)

  • Pipework survey carried out to establish routings

  • Moisture Mapping
  • Location

  • Sketch of area

  • 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
  • Use "Automatic" mode initially find anomalies then switch to "Manual/Lock" with 2 degree temperature Span and move temperature Level into anomaly temperature range for detailed colour graded image.

  • Location

  • Notes

  • Evidence (Context and detailed photo(s))

  • Acoustics Survey
  • Notes

  • Acoustics Survey Anomaly
  • Location

  • Notes

  • Evidence

  • Endoscope Survey
  • Notes

  • Endoscope Survey Anomaly
  • Location

  • Notes

  • Evidence

  • Supply Pipe Survey
  • Notes

  • Location
  • Location

  • Notes

  • Evidence

  • Other Inspection/Survey Works
  • Notes

  • Other Works
  • Notes

  • Evidence

Tracer Gas Survey

    Tracer gas survey
  • Drain down the system being Tracer Gassed. Securely fix hose(s) to drain points with jubilee clip(s). If central heating - check for multiple drain cocks/spigots, open bleed valves (highest points first). Hot/Cold water systems - open taps to assist drain down.

  • Insert gas to 0.5 Bar initially - check for leakage. Then raise pressure to 1.0/1.5 Bar gradually. Do not increase pressure over 1.5 Bar other than in exceptional circumstances.

  • System/location

  • Notes

  • System drained down

  • Expect the Tracer Gas to take longer to manifest

  • Reason/notes

  • Boiler switched off/isolated

  • BOILER MUST BE SWITCHED OFF/ISOLATED

  • Notes/Reason for not isolating the boiler

  • Is the water clear or very discoloured when draining down

  • All radiator bleed valves on central heating system closed or taps on hot/cold water system closed

  • Close all radiator bled valves and/or taps before introducing gas

  • Notes

  • Central Heating - All radiators fully open on both sides. (note original settings and reset after)

  • Ensure all radiators are fully open before introducing gas

  • Notes

  • Central Heating/Hot Water Heating - All zone/diverter valves manually set to open

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

  • Central Heating - 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 filling point

  • Evidence

  • Gradually increase Tracer Gas pressure from 0.5 Bar to 1.0/1.5 BAR

  • Maximum tracer gas pressure used

  • Photo of pressure gauge on gas rig

  • Pressure loss

  • Pressure loss over time period

  • Gas detected internally

  • Notes

  • Evidence

  • Gas detected 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

  • Amount of inhibitor added

  • Leak sealing agent added

  • Additional charge may apply

  • Reason/notes

  • Amount of sealing agent added

Asbestos Removal

    Asbestos Containing Material Removal
  • Are you qualified to remove Asbestos Contain Materials

  • DO NOT PROCEED WITH REMOVAL - REMOVAL MUST BE CARRIED OUT BY QUALIFIED OPERATIVES ONLY

  • Location

  • Is the ACM removal non licenced works (either presumed or confirmed)

  • DO NOT PROCEED UNLESS YOU ARE A LICENCED ASBESTOS REMOVAL OPERATIVE

  • Are you a licenced asbestos removal operative

  • ACM Type

  • Description of material

  • Continue under controlled ACM removal conditions including RAMS and appropriate PPE/RPE

  • Notes

  • Before photos

  • After photos

  • DO NOT PROCEED - REMOVAL MUST BE CARRIED OUT BY LICENSED OPERATIVE(S)

  • ACM Type

  • Description of material

  • Continue under controlled ACM removal conditions including RAMS and appropriate PPE/RPE

  • Notes

  • Before photos

  • After photos

Excavation

    Excavation
  • HAS THE OCCUPANT GOT SUFFICIENT WATER RESERVES FOR THEIR NEEDS IF THE WATER SUPPLY IS INTERRUPTED. Filled containers, pots, pans, cisterns and/or bath.

  • 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 understands and excepts that utility services maybe disrupted until such time as a repair or other works can be carried out.

  • Customer contact advised of reasons for excavation prior to works commencing - our terms & conditions apply regarding excavation

  • Reason customer not advised

  • 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 of Excavation
  • 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 Infrared Camera 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

  • Additional notes

Conclusion

  • Discussion

  • Conclusion

  • Evidence

  • 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 (subrogation )

  • Notes

Recommendation

  • Recommendation(s)

  • Notes

  • Does the property require professional drying

  • Reason

  • Notes

Time Summary Key Account Instructions)

  • Time on Site (Total Time)

  • Time on Tracer Gas

  • Time on Excavation

  • Time on Asbestos Removal

  • Other Time Details

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.