Insured/Company Name
Policy Number
Name
Email Address
Telephone Number
(please note a desktop survey will take place over the phone)
Address Line 1
Address Line 2
Town
County
Postcode
Broker Company Name
Broker Contact Email
Please select 3 preferred dates (a maximum of 2 weeks into the future) and our surveyor will be in touch to confirm a suitable time (between 9am and 5pm).
Your Main Trade —Please choose an option—ScaffoldingRoofingWaste & RecyclingOther
[group group-scaffolding]
Survey Documents Required: Scaffolding
You will be required to provide the documents outlined below along with additional documents specific to your business and activities which will be discussed during the survey. Please confirm if you have the documents below and upload copies if available:
Please note: If you do not have the documents to hand, you will have an opportunity during and after the survey to upload the relevant documents you have.
SSIP Accreditations Certificates (CHAS, Construction Line, Safe Contractor, SMAS, Achilles etc.) YesNoN/A
Health & Safety Policy / Safety Statement YesNoN/A
Risk Assessments for 3 Recent Projects or 3 tasks with high risk such as use of plant and machinery YesNoN/A
Letter of Engagement with Safety Advisor / CV of Safety Advisor / Description of Services Provided by Safety Advisor YesNoN/A
Health & Safety Qualifications Held by Director(s), Manager(s) and/or Supervisor(s) YesNoN/A
Scaffolding Industry Qualifications YesNoN/A
Records of H&S Related Training provided to employees/operatives including manual handling, working at height, asbestos awareness, company induction, first aid, abrasive wheel or any other H&S related training YesNoN/A
Training Matrix YesNoN/A
Scaffolding Handover Certificate Process/Policy and examples YesNoN/A
Personal Protective Equipment Issue Register YesNoN/A
Safety Harness Training and Inspection Records YesNoN/A
Face Fit Training Records YesNoN/A
Health & Safety Audit Reports and Workplace Inspection Records YesNoN/A
[/group]
[group group-roofing]
Survey Documents Required: Roofing
[group group-waste-recycling]
Survey Documents Required: Waste & Recycling
WAMITAB Training Certificates YesNoN/A
Plant & Equipment Training Records/Certification and Inspection Records YesNoN/A
Fire Risk Assessment, Fire Alarm System Inspection or Servicing Records, Firefighting Equipment Inspection Records and Fire Suppression Inspection Records YesNoN/A
[group group-others]
Survey Documents Required: Other
Statement:
As per the terms and conditions of your policy, it is understood and agreed that the Insured’s Policy is subject to a satisfactory survey within 30 days of inception for a “desktop survey” or 45 days for a “site survey”. A desktop survey will comprise of a telephone interview with the Insured. A site survey will comprise of a site visit to either the Insured's business premises or a working site. This will be followed by a review of documentation to be supplied by the Insured on this form, at the time of the survey or within 48 hours of completing the interview. The Insurer reserves the right, notwithstanding any Policy terms and conditions, as follows:
a) In the Event that the survey proves unsatisfactory, in the opinion of the Insurer, to cancel cover immediately and with no prior notice;
b) To alter or amend the terms and conditions of the Policy;
c) To require that the Insured complies with the recommendations or requirements of the surveyor at the Insurer's discretion and within a time period set by the Insurer;
d) In the Event the telephone interview is cancelled on the day of the agreed interview or the agreed staff member/ members of the Insured are not available on the agreed day for said interview, the Insured will be liable for the surveyor's cancellation fee.
e) In the Event documentation is not supplied within 48 hours following the interview with the surveyor, the Insured may be liable for any additional cost incurred for the reviewing of documentation after this period.
By using this form you understand and agree to the statement above. By using this form you agree that the information provided is accurate. By using this form you agree with the storage and handling of your data by this website.
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