Design Change / Construction Change Notification Form

Please complete this form to notify the Principal Designer and relevant parties of any proposed design, construction, sequencing or scope changes that may affect health, safety, temporary works, coordination or project risks.

If a question does not apply, please enter N/A or select None Known. If you experience any issues completing this form, please contact pd@evolutionsafetysolutions.co.uk.

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1. Submitter Information

Your Name

Your Email Address

Company / Organisation Name

Your Role on the Project

—Please choose an option—ClientPrincipal DesignerPrincipal ContractorArchitectStructural EngineerM&E ConsultantSpecialist DesignerSite ManagerSubcontractorTemporary Works CoordinatorOther

If Other, please provide details

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2. Project Information

Project Title

Project Address

Change Notification Date

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3. Type of Proposed Change

Please identify the nature of the proposed change.

Design ChangeStructural ChangeArchitectural ChangeM&E ChangeTemporary Works ChangeConstruction Sequence ChangeProgramme ChangeSpecification ChangeMaterial ChangeAccess / Logistics ChangeDemolition ChangeSite Layout ChangeTraffic Management ChangeFire Strategy ChangeScope IncreaseScope ReductionOther

If Other, please provide details

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4. Description of Proposed Change

Detailed Description of the Proposed Change

Please clearly explain what is changing and why the change is being proposed.

Reason for Change

—Please choose an option—Client InstructionDesign DevelopmentSite ConditionsCoordination IssueValue EngineeringBuildability IssueProgramme RequirementSafety ConcernRegulatory RequirementMaterial AvailabilityOther

If Other, please provide details

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5. Potential Health & Safety Impacts

Please identify any potential health, safety or welfare impacts resulting from the proposed change.

Additional Work at HeightStructural Stability RiskTemporary Works ImplicationsAdditional Excavation RiskConfined Space RiskFire Risk ChangesPublic Protection ChangesTraffic Management ChangesService Strike RiskMaintenance Access ChangesProgramme Overlap RisksInterface with OccupantsEnvironmental RisksNo Significant Additional RisksOther

If Other, please provide details

Health & Safety Impact Details

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6. Temporary Works & Sequencing Impacts

Please identify whether the change affects temporary works or construction sequencing.

Temporary Propping RequiredRevised Demolition SequenceRevised Installation SequenceAdditional Crane / Lifting OperationsAccess ChangesScaffold ChangesTraffic Management ChangesNo Significant Sequencing ChangesOther

If Other, please provide details

Temporary Works / Sequencing Notes

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7. Impacted Parties

Please identify which parties may be affected by this proposed change.

ClientPrincipal DesignerPrincipal ContractorArchitectStructural EngineerM&E ConsultantTemporary Works CoordinatorSubcontractorsBuilding ControlOccupants / End UsersPublicOther

If Other, please provide details

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8. Required Actions

Actions Required Before Change Can Proceed

Please identify any approvals, revised calculations, drawings, permits, RAMS or coordination actions required.

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9. Supporting Documents

Please upload any revised drawings, sketches, calculations, RAMS, mark-ups, photographs or supporting information.

If no documents are available, please upload a simple note stating “No documents available”.

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10. Additional Comments

Additional Comments

Enter N/A if you have no further comments.

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11. Declaration

Please confirm that the information provided is accurate to the best of your knowledge.

[acceptance* declaration] I confirm that the information provided within this form is accurate and complete to the best of my knowledge. [/acceptance]