William Hill Installation

• Customer

• Site Address

• Post code

• Date of Inspection

  Date

• Inspected by

• Site reference (if applicable)

Contact Information

• What is the company interest in the property?

  Owned

  Leased

  Freehold

  Tenant

• Has consent been obtained?

  Yes

  No

• Building Management Contact

• Address

• Phone Number

• Owner of premises

• Phone Number

• Address

• Are accurate plans, elevations and ordinance survey plans available?

  Yes

  No

• State where and whom relevant copies could be obtained from?

• Is further action required?

  Yes

  No

• Please provide details

Location and planning

• Is the proposed dish / aerial location in your opinion likely to cause problems with local permissions?

  Yes

  No

• Please give details

• Can the proposed dish/aerial location be viewed by adjacent, higher properties?

  Yes

  No

• Is the building listed?

  Yes

  No

• Please give details

• Is the property in a conservation area?

  Yes

  No

• Please provide details

• Local Planning Authority

• Name

• Address

• Telephone

• IT IS THE RESPONSIBILITY OF WILLIAM HILLTO OBTAIN LANDLORDS OR BUILDINGS PERMISSION FOR ANY DISH OR AERIAL

TV / Satellite Details

• SIS Satellite: Sirius II 5 East 90cm (min) Height above ground (m)

• Sky Digital: 28.2 East 60 cm (min) Height of Sky Dish above ground (m)

• TV: State Transmitter type

• Height of aerial above ground (m)

• Describe dish location for SIS and Sky digital antennas ( NB. Not on front of building or detract, obstruct or interfere with windows, doors, logos or signage etc)

• Is the full arc viewable from this position?

  Yes

  No

• Which satellites are affected?

  Select Sky digital Astra Sirius II Intelsat 707 Intelsat 605 Orion

  • Sky digital
  • Astra
  • Sirius II
  • Intelsat 707
  • Intelsat 605
  • Orion

• State obstructions

• Describe location for TV aerial ( NB. Not on front of building or detract, obstruct or interfere with windows, doors, logos or signage etc)

• Is there any possibility of future blockage caused by trees or future building works

  Yes

  No

• Please provide details

Dish and Aerial mounts

• Check box for relevant dishes

• SIS

• Mounts

  Wall

  Pole

  NPR

  Cladding

  Other

• If other, please describe

• Details of building structure at dish position

  Select Brick Stone Concrete Asphalt Cladding Other

  • Brick
  • Stone
  • Concrete
  • Asphalt
  • Cladding
  • Other

• If other, please describe

• Condition of building structure

• Sky

• Mounts

  Wall

  Pole

  NPR

  Cladding

  Other

• If other, please describe

• Details of building structure at dish position

  Select Brick Stone Concrete Asphalt Cladding Other

  • Brick
  • Stone
  • Concrete
  • Asphalt
  • Cladding
  • Other

• If other, please describe

• Condition of building structure

• TV Aerial

• Mounts

  Wall

  Pole

  NPR

  Cladding

  Other

• If other, please describe

• Details of building structure at aerial position

  Select Brick Stone Concrete Asphalt Cladding Other

  • Brick
  • Stone
  • Concrete
  • Asphalt
  • Cladding
  • Other

• If other, please describe

• Condition of building structure

Cable and Route Fixing

• Describe cable route from dishes/aerial to headend:

• Will wall penetration be required for the IF / TV cable?

  Yes

  No

• If Yes, give details of hole size, wall thickness and sealant required

General

• Are there any special equipment/materials required

  Yes

  No

• Please give details

• Ladders required

• Select T12 T14 T16 T18 T20 T22

  • T12
  • T14
  • T16
  • T18
  • T20
  • T22

• Cherry picker required

• Please give details

• Is scaffold required?

• Please give details

• Full access available to complete survey

  Yes

  No

• Please give details

• Parking arrangements required

  Yes

  No

• Please give details

• Trunking or conduit required

  Yes

  No

• Give details

• Easy access for equipment and blocks

  Yes

  No

• Provide details

Cable Type required (eg 100, 125, 165)

• SIS (state type and length)

• Sky (state type and length)

• TV (state type and length)

Fixings

• Clips (type and quantity)

• Cable ties (type and quantity)

• Saddles (type and quantity)

• Conduit (type and quantity)

• Trunking (type and quantity)

• Other (type and quantity)

Cable / receiver location

• Describe cable route and fixing methods

• Describe receiver location in premises (include floor level and room identification)

• Is there room for the receiver?

  Yes

  No

• Installed to:

  Shelf

  Desk

  Equipment rack

  Cupboard

  Other

• Please describe

• Has this location been agreed?

  Yes

  No

• Are two mains power sockets available?

  Yes

  No

• Are there nearby telephone sockets?

  Yes

  No

• Is the room locked?

  Yes

  No

• Key holder is:

• Any access or trunking comments?

  Yes

  No

• Please describe

General

• Was full access available to complete survey?

  Yes

  No

• Please give details

• Can the installation proceed immediately?

  Yes

  No

• Please give details

• Indicate hours that installation can take place

• Indicate any access or security restrictions

• Specific parking arrangements required

  Yes

  No

• Give details

• Estimate on days / hours to complete installation

• Give details of any non essential extras / reasons to prevent installation if any:

Photographs

• Photographs are required from site and presented with survey. Please ensure all dish positions and cable runs are highlighted on photographs

• Elevation 1 of building

  Media

• Elevation 2 of building

  Media

• Dish location

  Media

• Any existing dishes

  Media

• A view from the dish position looking south

  Media

• The external cable entry point

  Media

• Proposed receiver location

  Media

• Viewing points

  Media

• Any additional notes

Aerial view of building

• Highlight dish locations, existing dishes, size, service, direction of south, adjacent roads, cable routes and distance in metres

• Aerial view of the building showing proposed dish location, existing dishes and their service

  Media

• Internal sketch showing positions of receiver, mains power points, cable routes, conduit to be run and cable entry points

  Media

Risk Assessment

• Is there leaning ladder work?

  Yes

  No

• HARM - falls, serious injury, death, objects falling PERSONS AT RISK - operatives / members of the public RISK - High CONTROLS - Operatives must have valid working at height certificate. Ladders must be in good condition and subject to pre use inspection. Ladders must be set on firm level ground at the correct angle (1 in 4). Ladders should be stabilised top and bottom through the use of stabilizer and microlite. All ladders must be secured via eye bolt and ratchet straps. Safety harness must be worn and attached using rope grab and rope to maintain three points of contact. All equipment such as drill must be secured using drill straps RESIDUAL RISK - medium

• Any additional controls required

• Please describe

• Is there step ladder work?

  Yes

  No

• HARM - falls, serious injury, death, objects falling PERSONS AT RISK - operatives / members of the public RISK - High CONTROLS - Operatives must have valid working at height certificate. Ladders must be in good condition and subject to pre use inspection. Ladders must be set on firm level ground at the correct angle. Equipment such as drill must be secured using drill straps RESIDUAL RISK - medium

• Any additional controls required

• Please describe

• Is there flat roof work?

  Yes

  No

• HARM - falls, serious injury, death, objects falling PERSONS AT RISK - operatives / members of the public RISK - High CONTROLS - Where no edge protection is available, a 2m exclusion zone must be set up. Work within the exclusion zone, operatives must be attached to a dead mans anchor and fall restraint lanyard. If latch way system is available, operatives must check that latch way is within inspection period and if not, must not use. Where anchor points are available these must be within the inspection period and certified by a competent person. Fixed edge protection must be 950mm high as a minimum requirement. RESIDUAL RISK - Medium

• Any additional controls required

• Please describe

• Is there pitched roof work?

  Yes

  No

• HARM - falls, serious injury, death, objects falling PERSONS AT RISK - operatives / members of the public RISK - High CONTROLS - CAT ladders must be used on all pitched roof works. Access ladders must extend 1.2m above the gutter line and must be secured at the top with stand off and stabilised at the bottom. Eye bolts and ratchet straps must be used to secure the access ladder. CAT ladders must span the roof fully, have a rope system attached and be strapped to the access ladder. RESIDUAL RISK - Medium

• Any additional controls required

• Please describe

• Is there drilling activities work?

  Yes

  No

• HARM - exposure to dust inhalation/eye injuries PERSONS AT RISK - operatives / members of the public RISK - Medium CONTROLS - Face masks must be worn at all times whilst drilling or working in dusty environments. Work area must be cordoned off by means of cones, barrier tape and signage to to warn people of works taking place. Eye protection must be worn at all times. RESIDUAL RISK - Low

• Any additional controls required

• Please describe

• Is there dust exposure?

  Yes

  No

• HARM - ill health from exposure to dust inhalation PERSONS AT RISK - operatives / members of the public RISK - Medium CONTROLS - Face masks must be worn at all times whilst drilling or working in dusty environments. Work area must be cordoned off by means of cones, barrier tape and signage to to warn people of works taking place. RESIDUAL RISK - Low

• Any additional controls required

• Please describe

• Will there be work from scaffolding?

  Yes

  No

• HARM - Falls from height when using scaffolding / serious injuries / death PERSONS AT RISK - operatives / members of the public RISK - High CONTROLS - Operatives under no circumstances must access an incomplete scaffold unless inspected by a competent person and tagged to confirm as safe. (This must be completed every 7 days or following inclement weather/collision). Scaffold must only be erected or altered by an approved company or person. If in doubt contact the Health and Safety Department. RESIDUAL RISK - Low

• Any additional controls required

• Please describe

• Will there be work in public places or contact with public?

  Yes

  No

• HARM - People becoming abusive / risk of attack PERSONS AT RISK - Operatives / members of the public RISK - High CONTROLS - Operatives to avoid confrontation with members of the public, and customers. Walk away from confrontation situations. Ensure work areas are suitably cordoned off using cones and barrier tape. RESIDUAL RISK - Low

• Any additional controls required

• Please describe

• Will there be manual handling?

  Yes

  No

• HARM - Manual handling injuries / sprains / torn ligaments PERSONS AT RISK - Operatives RISK - High CONTROLS - Operatives to assess the following: Load (what is being lifted) Individual (person or persons involved in the lift) Task (can this be avoided or done mechanically aided) Environment (what are the local conditions, are walkways clear) All operatives have been trained in manual handling techniques. RESIDUAL RISK - Low

• Any additional controls required

• Please describe

• Will there be work in a confined space?

  Yes

  No

• HARM - Serious injury / death PERSONS AT RISK - Operatives RISK - High CONTROL - Ensure adequate lighting is available prior to entry. Hard hat or bump cat to be worn to prevent injury. All items to be removed from space before entry and a safe working area established. An emergency plan must be drawn up and in place prior to works starting. RESIDUAL RISK - Medium

• Any additional controls required

• Please describe

• Will there be work on electrical systems?

  Yes

  No

• HARM - Serious injury / death / fire PERSONS AT RISK - Operatives RISK - High CONTROLS - Visual checks must be carried out by operative before work commences. Ensure wires are not frayed and are in good condition. All work on electrical systems must be undertaken by a competent person and systems isolated and verified dead prior to work commencing. RESIDUAL RISK - Medium

• Any additional controls required

• Please describe

• Will the work generate noise?

  Yes

  No

• HARM - Hearing loss / Partial deafness PERSONS AT RISK - Operatives RISK - Medium CONTROLS - Hearing protection must be worn when undertaking noisy activities such as drilling. Noise levels must not exceed 85 dB. Further guidance can be sought from the Health and Safety Department RESIDUAL RISK - Low

• Any additional controls required

• Please describe

Works involving MEWP / Cherry picker

• Will the work involve a MEWP or cherry picker?

  Yes

  No

• B1. Overhead Electricity

  Yes

  No

• HAZARD - Overhead Electricity
  

• HARM - Striking electrical cables / Electrocution
  
  PERSONS AT RISK - Operatives
  
  RISK RATING - High

• CONTROLS - This must be identified at survey stage. If there is even a remote chance that an overhead cable could be contacted then work must stop immediately. Do not continue to operate equipment

• RESIDUAL RISK - Medium

• Additional controls required

• Outline additional controls

• B2. Equipment Failure

  Yes

  No

• HAZARD - Equipment Failure
  

• HARM - Serious injury or death
  
  PERSONS AT RISK - Operatives
  
  RISK RATING - High

• CONTROLS - Equipment to be maintained and examined as per LOLER Regulations. All mechanical parts to be included in MEWP engineers examination. Equipment to be tagged and valid certification to be held on equipment. Operator to carry out pre use check on equipment

• RESIDUAL RISK - Medium

• Additional controls required

• Outline additional controls

• B3. Falls and Falling objects

  Yes

  No

• HAZARD - Falls and Falling objects
  

• HARM - Injuries to those below from falling objects
  
  PERSONS AT RISK - Operatives / members of the public
  
  RISK RATING - High

• CONTROLS - No materials to hang over the side of the handrails. Operator must not hang over hand rails. Equipment must not be over loaded. Work area to be cordoned off using cones and barriers. If working in public highway must comply with New Roads and Street Works Act

• RESIDUAL RISK - Medium

• Additional controls required

• Outline additional controls

• B4. Falls from height

  Yes

  No

• HAZARD - Falls from height

• HARM - Serious injury / death
  
  PERSONS AT RISK - Operatives
  
  RISK RATING - High

• CONTROLS - Only competent IPAF trained persons to operate MEWP

• RESIDUAL RISK - Medium

• Additional controls required

• Outline additional controls

• B5. Overloading Equipment

  Yes

  No

• HAZARD - Overloading causing instability / toppling
  

• HARM - Serious injury / death / property damage
  
  PERSONS AT RISK - Operatives
  
  RISK RATING - High

• CONTROLS - Equipment is not be used as crane and must be operated within the safe working load as per manufacturers instructions.

• RESIDUAL RISK - Medium

• Additional controls required

• Outline additional controls

• B6. Parking of MEWP

  Yes

  No

• HAZARD - Parking of MEWP
  

• HARM - Unauthorised persons accessing
  
  PERSONS AT RISK - Operatives
  
  RISK RATING - High

• CONTROLS - Vehicle must be left in safe place, all electrics isolated and keys kept by operator. Physical barriers may be required to restrict access

• RESIDUAL RISK - Medium

• Additional controls required

• Outline additional controls

• B7. Work in adverse weather

  Yes

  No

• HAZARD - Instability of MEWP
  

• HARM - Toppling of MEWP
  
  PERSONS AT RISK - Operatives
  
  RISK RATING - High

• CONTROLS - All operations will cease in adverse weather conditions such as high winds, driving rain, thunderstorms, lightening and snow/ice

• RESIDUAL RISK - Medium

• Additional controls required

• Outline additional controls

• B8. Accessing roof area

  Yes

  No

• HAZARD - Fall from height / leaving basket to access roof
  

• HARM - Fall from height
  
  PERSONS AT RISK - Operatives
  
  RISK RATING - High

• CONTROLS - Work area should be segregated from members of the public through use of cones / barriers. The MEWP arm must be fully extendable and placed a suitable distance on to the roof to the 2m exclusion zone. Operatives must be kept attached via a fixed lanyard at all times including exiting the basket until a safe distance can be maintained.

• RESIDUAL RISK - Medium

• Additional controls required

• Outline additional controls

Additional information

• Any additional comments

• Any additional photos

  Media

Sign Off

• Engineer

  Sign

• Client Name

• Position

• Client representative (if available)

  Sign