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A notification form for construction projects that need to be reported to the Health and Safety Executive (HSE) under the Construction (Design and Management) Regulations 2007. The form requires the project address, notification type, local authority information, and details about the CDM coordinator, principal contractor, and other contacts. It also asks for a brief description of the project and the construction work it includes, as well as estimates for time allowed, planned start and duration of the construction phase, and maximum number of people and contractors on site.
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Health and Safety Executive
Page 1
**1. Guidance notes for completion - Please complete in block capitals using black ink
The Data Protection Act 1998 required the Health and Safety Executive (HSE) to inform you that this form may include information about you (this is called 'personal data' in the Act) and that we are a 'data controller' for the purposes of this Act. HSE will process these data for health, safety and environmental purposes. HSE may disclose these data to any person or organisation for the purpose for which it was collected or where the Act allows disclosure. As data subject, you have the right to ask for a copy of the data and to ask for any inaccurate data to be corrected.
Is this the initial notification of the project or are you providing additional information not previously available?
**3. Date of forwarding this notification or provision of additional information?
Health and Safety Executive
Page 1
Address Name Street*
District
Town* County
Country* (^) Postcode*
Initial Notification Additional Information
Are there multiple construction sites Yes^ No^ (Please give the main address below)
England Wales Scotland
(Mandatory fields are marked with an asterisk(*))
What should this form be used for
Where to send the completed form
When to send this form
F10 (11.11) 51328
Executive
Not Required Asbestos Building Services Utilities Work
Painting&Decorating Road & Path Site Investigation Telecomm. Towers
Tunnel Water Project Other
House Factory Chimney Railways
Other
Installation Repair
Residential Commercial Other
Piling Tunnelling Underpinning Other
Bridge Road Waterway Docks
New Build - Railways New Build - Other
Shop Warehouse Factory Other
Houses 0 - 5 Houses 5 - 10 Houses 10 - 20 Houses > 20
Flats 0 - 5 storey Flats 5 - 10 storey Flats 10 - 20 storey Flats > 20 storey
Other
Commercial Residential Railway Other
Bridge Road Waterway Docks
Other
6 a. Project type - IMPORTANT: Please select ONE checkbox only from this page
Refurbishment (including Repair & Redecoration)
New Build - Residential Premises
New Build - Commercial Premises
New Build - Civil Engineering
Groundworks
Roofwork Repair
Mechanical & Electrical (M & E)
Demolition/Dismantling
For mixed projects please tick the box that reflects the primary element of the work. Additional information may be provided on the following page in section 6 b.
Refurbishment (including Repair & Redecoration) - Civil Engineering
1 - 5 storey 6
51328
Executive
**11. Name and address of any contractors already appointed
Postcode*
County
Town*
District
Street*
Address Name
Country*
Name*
Email Address
Telephone
Name* Address Name Street*
District
Town*
County
Country*
Telephone Email Address
Postcode*
England Wales Scotland
England Wales Scotland
Name* Address Name Street*
District
Town*
County
Country*
Telephone Email Address
England Wales Scotland Postcode*
51328
Executive
13. Please give your estimates of the following: 12. Time allowed 14. Please fill in the following sections if you have additional addresses that you need to let us know about
Time allowed by the client to the principal contractor (contractor referred to in regulation 15(b))
Planned date for the start of the construction phase*
Planned duration of the construction phase*
Maximum number of people at work on site at any one time Planned number of contractors on the site
weeks
for the planning and preparation for construction work: weeks
Name* Address Name Street*
District
Town*
County
Country*
Telephone Email Address
Postcode*
Specify the type of contact*: Client^ Designer^ Contractor
England Wales Scotland
Name* Address Name Street*
District
Town*
County
Country*
Telephone Email Address
Postcode*
Specify the type of contact*: (^) Client Designer Contractor
England Wales Scotland
51328