PCI / Existing Information Request Form

Please complete this form as fully as possible. If something does not apply, enter N/A or select None Available / None Known.

If you have any issues completing this form, please email pd@evolutionsafetysolutions.co.uk.

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1. Your Details

Your Name

Your Email Address

Organisation / Company Name

Your Role on the Project

—Please choose an option—ClientArchitect / DesignerStructural EngineerM&E ConsultantSurveyorPrincipal ContractorContractorPlanning ConsultantBuilding ControlOther

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2. Project Details

Project Title

Project Address

Planning Application Reference Number

Enter N/A if not applicable.

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3. Drawings & Design Information

Please select any drawings or design information currently available.

Existing PlansProposed PlansElevationsSectionsSite Location PlanBlock PlanRoof PlansStructural DrawingsM&E DrawingsDrainage DrawingsFire Strategy DrawingsTemporary Works DrawingsNone Available

Drawing / Design Information Notes

Enter N/A if you have no further comments.

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4. Surveys, Reports & Investigations

Please select any surveys, reports or investigations currently available.

Topographical SurveyUtility SurveyDrainage SurveyCCTV Drainage SurveyAsbestos SurveyRefurbishment and Demolition Asbestos SurveyStructural SurveyGround Investigation ReportContamination ReportFlood Risk AssessmentEcology ReportArboricultural ReportNoise SurveyFire Strategy ReportTraffic Management AssessmentParty Wall InformationNone Available

Survey / Report Notes

Enter N/A if you have no further comments.

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5. Existing Services & Utilities

Please select any known services or utilities on or near the site.

ElectricityGasWaterDrainageTelecommunicationsFibre / DataOverhead CablesUnderground ServicesPrivate Drainage / Septic TankUnknownNone Available

Existing Services / Utilities Notes

Enter N/A if you have no further comments.

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6. Existing Hazards & Site Constraints

Please select any known hazards or site constraints.

AsbestosContaminated GroundUnderground ServicesOverhead Power LinesRestricted AccessShared AccessPublic InterfaceAdjacent HighwayAdjacent RailwayWatercourse / Flood RiskRetaining WallsFragile StructuresUnstable GroundOccupied PremisesNeighbouring Properties AffectedNone Known

Additional Hazard / Constraint Details

Enter N/A if you have no further comments.

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7. Existing Health & Safety Information

Please select any existing health and safety information available for the site or building.

Previous Health & Safety FileO&M ManualsAs-Built DrawingsFire Risk AssessmentLegionella Risk AssessmentAccess StrategyMaintenance RecordsPrevious Construction RecordsNone Available

Existing Health & Safety Information Notes

Enter N/A if you have no further comments.

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8. Statutory / Third Party Information

Please select any statutory, legal or third-party matters known at this stage.

Planning ConditionsBuilding Control CommentsParty Wall MattersListed Building ConsentConservation Area ConstraintsHighways RequirementsEnvironmental Health RequirementsWater Authority RequirementsNetwork Rail / Rail Authority RequirementsUtility Provider RequirementsNone Known

Statutory / Third Party Notes

Enter N/A if you have no further comments.

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9. Document Upload

Please upload any available drawings, surveys, reports, photographs or supporting information.

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10. Additional Comments & Declaration

Additional Comments

Enter N/A if you have no further comments.

Declaration

I confirm that the information provided is accurate and complete to the best of my knowledge.