Door Safety Risk Assessment Survey Form Refer to the Risk Assessment Guide before completing this form
Site Name/Address:
Survey completed by:
Date:
Telephone No:
Approved by:
Date:
Sheet:
For price quotation fax this formto: 01708 855 125 or copy and post to address below.
Colours
Hinge Cavity (HC) Standard
Door No.
HC-
Non Standard
Standard Extended
Non Std. Extended
HC-N-
HC-X-
HC-N-X-
Colour
use code above i.e. WHI for white
WHI
GRY
White
of BEE
Grey
Beech
MAH
Mahogany
Hinge Pin (HP)
Handle Side (HS)
Slide Panel (SP)
One Size
One Size (White)
Size 1 (White)
Size 2 (White)
Size 3 (White)
One Size (Black)
HS
SP45
SP50
SP55
DG
HP-
Colour
use code above i.e. WHI for white
Fire Dorgard (DG)
If you require any assistance with your DIY risk assessment survey call the Safety Assured Advice Line on 0870 060 1715 or ask for details about our certified survey and fitting service Safety Assured Limited Innovation House 385 Chepstow Avenue Hornchurch, Essex RM12 6AU United Kingdom T: +44 (0)1708 855 777 F: +44 (0)1708 855 125 E: info@fingerprotector.co.uk www.safetyassured.com
Š 2004 Safety Assured Limited Issue 08-04 TechDoc 01:02