Validation Report

• Client Reference Number

• Policy Holder Name

• Policy Holder Address

• Conducted on

  Date

• Enquiry Number

• Prepared by

• Location
  Address

• Landline Number

• Mobile Phone Number

• E-Mail Address

• Preferred Method of Contact

  Either

  Mobile

  E-Mail

• Alternative Accomodation

  Yes

  No

• Address ( If Known )

• Landline Number ( If Known )

• Tenant

  Yes

  No

• Tenant Name

• Tenant Contact Number

• Tenant E-Mail Address

• Building Type

• Photograph of Property

  Media

• Approximate Year of Construction

• Occupied Property

  Yes

  No

• Cause of Damage

  Select Escape of Water Ingress of Water Fire Flood Subsidence Storm Impact Other

  • Escape of Water
  • Ingress of Water
  • Fire
  • Flood
  • Subsidence
  • Storm
  • Impact
  • Other

• Type of Damage

• Gas Meter

  Yes

  No

• Location

• Photograph

  Media

• Gas Check Required

  Yes

  No

  N/A

• Mains Water Stop Cock

  Yes

  No

• Location

• Photograph

  Media

• Electric Meter / Distribution Board

  Yes

  No

• Location

• Photograph

  Media

• Electrical Test Required

  Yes

  No

  N/A

• Boiler

  Yes

  No

• Location

• Photograph

  Media

• Type of Boiler

  Combi

  System

  Heat Only

  Oil Fired

  Other

• Type of Boiler Fitted

• Is Boiler Working

  Yes

  No

• Why is Boiler not working

• Key Safe Required

  Yes

  No

• Location

• Keysafe Number

• Photograph

  Media

• Access Given By Policy Holder

  Yes

  No

• Alarm

  Yes

  No

• Location of Panel

• Photograph

  Media

• Alarm Code / Fob

  Alarm Code

  Fob

  Other

• Alarm Code

Internal Areas

• Rooms

  Select Lounge Sitting Room Dining Room Kitchen Kitchen / Diner Utility Room Boot Room Study Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom 5 Bedroom 6 En Suite En Suite 2 Bathroom1 Bathroom 2 Shower Room Sauna Upstairs Toilet Downstairs Toilet Conservatory ( Internal ) Entrance Hall Stairway Understairs Cupboard Landing Landing 2 Hallway Porch Upstairs Hallway Basement / Cellar Garage Internal Other

  • Lounge
  • Sitting Room
  • Dining Room
  • Kitchen
  • Kitchen / Diner
  • Utility Room
  • Boot Room
  • Study
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bedroom 5
  • Bedroom 6
  • En Suite
  • En Suite 2
  • Bathroom1
  • Bathroom 2
  • Shower Room
  • Sauna
  • Upstairs Toilet
  • Downstairs Toilet
  • Conservatory ( Internal )
  • Entrance Hall
  • Stairway
  • Understairs Cupboard
  • Landing
  • Landing 2
  • Hallway
  • Porch
  • Upstairs Hallway
  • Basement / Cellar
  • Garage Internal
  • Other

• Define Room

• Length

• Width

• Height

• Floor Area / Wall / Perimeter

• Notes

• Photographs

  Media

• Drawing

  Yes

  No

• Annotate

  Drawing

• Suspected ACM's Found

  Yes

  No

• Location

• Type of Suspected ACM

  Select Asbestos Cement Board Spray Coating Textured Coating Thermoplastic Tiles Insulation Other

  • Asbestos Cement Board
  • Spray Coating
  • Textured Coating
  • Thermoplastic Tiles
  • Insulation
  • Other

• Define Suspected ACM Type

• Photographs

  Media

External Areas

• External Areas

  Select Front Elevation Rear Elevation RHS Elevation LHS Elevation Conservatory Driveway Garage Roof Carport Other

  • Front Elevation
  • Rear Elevation
  • RHS Elevation
  • LHS Elevation
  • Conservatory
  • Driveway
  • Garage
  • Roof
  • Carport
  • Other

• Fragile Roof

  Yes

  No

• Define External Area

• Length

• Height

• Width

• Floor Area / Wall Area / Floor Area

• Notes

• Photographs

  Media

• Drawing

  Yes

  No

• Annotate

  Drawing

• Suspected ACM's Found

  Yes

  No

• Location

• Type of suspected ACM

  Select Asbestos Cement Board Spray Coating Textured Coating Thermoplastic Tiles Insulation Other

  • Asbestos Cement Board
  • Spray Coating
  • Textured Coating
  • Thermoplastic Tiles
  • Insulation
  • Other

• Define Suspected ACM Type

• Photographs

  Media

• As Homeowner / Occupier, I give permission for the Staff of Pickford Builders Ltd and their Sub-Contractors to use the facilities Below

  Complete Certificate

• Sanitary Conveniences Provided Within the Property

  Yes

  No

• Sanitary Conveniences Provided via Portaloo

  Yes

  No

• Washing Facilities

  Yes

  No

• Rest Facilities, Provided within Trades Own Vehicle

  Yes

  No

• Water Supply

  Yes

  No

• Electric Supply

  Yes

  No

• Signature

  Sign

• Date

  Date

• The Signature below indicates that the " Responsible Person " identified, accepts for Pickford Builders Ltd, that should any person under the control of Pickford Builders Ltd or their Sub-Contractors, misuse any of the facilities provided, that person will be dismissed from site and any costs incurred may be charged to the company and that permission to use the facilities withdrawn.

• Name of Pickford Builders Ltd Responsible Person

  Sign

• Date

  Date

• Start Date Arranged

  Yes

  No

• Date

• Duration In Weeks

• Furniture Storage Required

  Yes

  No

• Areas Required

• Household Pets

  Yes

  No

• Type and Number of Pets

• Vulnerable Parties

  Yes

  No

• Description of Vulnerability

• Skip Required

  Yes

  No

• Location of Skip

• Photograph

  Media

• Parking Restrictions

  Yes

  No

• Details of Restictions

• Photograph of Drive/Road/Signage

  Media

• Highway Working

  Yes

  No

• Details of Highway Working

• Photographs

  Media

• Safe Access / Egress to Property

  Yes

  No

• Details of Property Access/Egress

• Photograph

  Media

• Full Scaffold Required

  Yes

  No

• Location of Scaffold

  Front Elevation

  Rear Elevation

  RHS Elevation

  LHS Elevation

  All Elevations

• Temporary Roof Required

  Yes

  No

• Photograph of Area To Be Scaffolded

  Media

• Scaffold Tower Required

  Yes

  No

• Ease and Adjust UPVC Doors/Windows

  Yes

  No

• Specify Windows or Doors To Be Adjusted

• Structural Engineer Visit Required

  Yes

  No

• Reason for Visit

• Additional LA Visit Required

  Yes

  No

• Reason for Visit

• Loss Adjuster

  360 Global Net

  Ellipta

  Sedgwick

  Questgate

  Other

• Name of Adjuster

• Building Regulations required

  Yes

  No

• Provide details

Planning or Listed Building Consent required

• Planning

  Yes

  No

  N/A

• Provide details

• Listed Building

  Yes

  No

  N/A

• Provide details

• Conservation Area

  Yes

  No

  N/A

• Provide details

• Site Plan

  Drawing

• Additional Comments

  Yes

  No

• Comments

• Excess

• Excess Payment

  BACS's

  Credit / Debit Card

  N/A

• Mandate Collected ( Questgate )

  Yes

  No

  N/A

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