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Job Assessment Form

Form to be completed by insulation installer seeking job assessment.

Prior to completing this form please read the Certified Insulation Installer Guide for Candidates and have all documentation and photos ready to complete this form. This form can be saved to return to later.

Applicant information

Hidden

Name(Required)

Prefix First Last

Prefix(Required)

Other prefix(Required)

Given name/s(Required)

Family name(Required)

Email(Required)

Certification number(Required)

Installation information

Details of insulation installation being submitted for assessment.

Application of insulation installed(Required)

Installation date(Required)

Installation must have occurred within the last six months.

Installation address(Required)

Street Address Address Line 2 City State Postcode Country

Installation company(Required)

Upload a copy of the job completion or confirmation form including the installation address, installation date, names of the installers on-site and summary of works completed.(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, pdf, doc, docx, heic, Max. file size: 5 MB, Max. files: 10.

Installation trainer or team supervisor

Details of the trainer, team supervisor or co-installer on-site on this job are required. This person may be contacted as part of the assessment process. If they are a Certified Insulation Installer you must include their Certification Number, which can be found here.

Given Name(Required)

Family Name(Required)

Job title(Required)

Supervisor company(Required)

Is this person an EEC Certified Certified Insulation Installer?(Required)

Yes

Installation supervisor's certification number(Required)

Contact email address(Required)

Contact mobile phone(Required)

Job Assessment Form: Ceiling Insulation

Photos

Please note that all photos must be geo-tagged and timestamped. Photos must not be blurry. Refer to the Guide for Candidates for more information.

Photo of ceiling space before installation(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Please provide photos of:

Power off and locked out and tagged for duration of install(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

The materials used satisfy the requirements of AS/NZS 4859.1(Required)

Yes

Please upload supporting documentation (e.g. invoice, job order, delivery notice etc.)(Required)

Drop files here or

Accepted file types: doc, docx, pdf, png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

If present, insulation around downlights in ceiling has satisfactory (but not excessive) clearance or fireproof enclosure, or fixtures must be IC-rated. If there were no downlights present, please check to certify below.(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Please confirm:

I certify that there were no downlights present

If present, insulation around electrical appliances in ceiling has satisfactory (but not excessive) clearance(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Provide photo evidence of any wiring hazards present(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Insulated ceiling space at job completion(Required)

including: - Under appliances and wiring - Under walk boards - Insulation depth matches job specifications (include photo of job specifications where insulation level is required) - No gaps in insulation coverage, except for hazards - All waste removed

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Hanging tape stapled to each truss/ceiling substrate when strung in (for new build only – i.e. for cathedral ceiling)(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Warning sign installed in the roof space if recessed luminaires are installed(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Safe Work Methods Statement

A SWMS associated with this job must be submitted with your application. Please confirm the SWMS addresses the following:

All wiring hazards present and how these hazards were resolved(Required)

All wiring hazards present and how these hazards were resolved

The procedure used to turn off the power(Required)

The procedure used to turn off the power

How batts were cut to size(Required)

How batts were cut to size

Which pieces of personal protective equipment (PPE) were used(Required)

Which pieces of personal protective equipment (PPE) were used

The signs of heat stress on days of high temperatures(Required)

The signs of heat stress on days of high temperatures

How installation was completed safely at height(Required)

How installation was completed safely at height

Please upload your safe work method statement(Required)

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 5 MB.

Job Assessment Form: Floor Insulation

Photos

Please note that all photos must be geo-tagged and timestamped. Photos must not be blurry. Refer to the Guide for Candidates for more information.

Please provide photos of:

Power off and locked out and tagged for duration of install(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

The materials used satisfy the requirements of AS/NZS 4859.1(Required)

Yes

Please upload supporting documentation (e.g. invoice, job order, delivery notice etc.)

Drop files here or

Accepted file types: doc, docx, pdf, png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Batts kept required distance from heat emitting devices(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, Max. file size: 5 MB, Max. files: 10.

Any wiring hazards present(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, Max. file size: 5 MB, Max. files: 10.

Insulated underfloor space at job completion, including:(Required)

- Full coverage of underfloor area, including around services (pipes, wires, etc) - Insulation depth matches job specifications - All waste removed

Drop files here or

Accepted file types: doc, docx, pdf, png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Any extra support (e.g., cross-strapping) present, if required per manufacturer’s instructions(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

If present, satisfactory clearance around electrical appliances(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Safe Work Methods Statement

A SWMS associated with this job must be submitted with your application. Please confirm the SWMS addresses the following:

All wiring hazards present and how these hazards were resolved(Required)

All wiring hazards present and how these hazards were resolved

The procedure used to turn off the power(Required)

The procedure used to turn off the power

How batts were cut to size(Required)

How batts were cut to size

Which pieces of personal protective equipment (PPE) were used(Required)

Which pieces of personal protective equipment (PPE) were used

Testing for non-conductivity of fixing devices and description of all fixing devices as non-conductive(Required)

Testing for non-conductivity of fixing devices and description of all fixing devices as non-conductive

Testing for non-conductivity of tools and description of all tools as non-conductive(Required)

Testing for non-conductivity of tools and description of all tools as non-conductive

Description of what you are checking for when checking clearances and crawlspaces prior to commencing work(Required)

Description of what you are checking for when checking clearances and crawlspaces prior to commencing work

Please upload your safe work method statement(Required)

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, heic, Max. file size: 5 MB.

Job Assessment Form: Wall Insulation

Photos

Please note that all photos must be geo-tagged and timestamped. Photos must not be blurry. Refer to the Guide for Candidates for more information.

Please provide photos of:

Wall space before installation(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Power off and locked out and tagged for duration of install(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

The materials used satisfy the requirements of AS/NZS 4859.1(Required)

Yes

Please upload supporting documentation (e.g. invoice, job order, delivery notice etc.)(Required)

Drop files here or

Accepted file types: doc, docx, pdf, png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Insulated wall space at job completion, including:(Required)

- Full coverage of wall area, including around obstructions and services (pipes, wires, etc) - Insulation depth matches job specifications - All waste removed

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Any wiring hazards present(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Batts do not protrude past wall studs(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, heic, Max. file size: 5 MB, Max. files: 10.

Mechanical support for holding batts in place, if required(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Installed pliable building membrane with appropriate level of membrane overlap(Required)

Drop files here or

Accepted file types: png, gif, jpeg, jpg, tiff, bmp, heic, Max. file size: 5 MB, Max. files: 10.

Safe Work Methods Statement

A SWMS associated with this job must be submitted with your application. Please confirm the SWMS addresses the following:

All wiring hazards present and how these hazards were resolved(Required)

All wiring hazards present and how these hazards were resolved

The procedure used to turn off the power(Required)

The procedure used to turn off the power

How batts were cut to size(Required)

How batts were cut to size

Which pieces of personal protective equipment (PPE) were used(Required)

Which pieces of personal protective equipment (PPE) were used

Testing for non-conductivity of fixing devices and description of all fixing devices as non-conductive(Required)

Testing for non-conductivity of fixing devices and description of all fixing devices as non-conductive

Testing for non-conductivity of tools and description of all tools as non-conductive(Required)

Testing for non-conductivity of tools and description of all tools as non-conductive

Please upload your safe work method statement(Required)

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 5 MB.

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Declaration

Confirm each item by ticking the checkbox, then complete and sign the declaration.

Declaration 1(Required)

All information contained in and attached to this form is true and correct and not misleading by inclusion or omission(Required)

Declaration 2(Required)

The above installation complies with AS3999(Required)

Declaration 3(Required)

A Safe Work Methods Statement has been completed for this job and submitted with this Job Assessment Form(Required)

Declaration 4(Required)

I have read and understood the Privacy Policy, and I have provided the installation trainer, team supervisor or co-installer named in this form with a copy of this Privacy Policy.(Required)

Signature (type your full name):(Required)

Phone

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Job Assessment Form

Form to be completed by insulation installer seeking job assessment.

Applicant information

Installation information

Installation trainer or team supervisor

Job Assessment Form: Ceiling Insulation

Photos

Safe Work Methods Statement

Job Assessment Form: Floor Insulation

Photos

Safe Work Methods Statement

Job Assessment Form: Wall Insulation

Photos

Safe Work Methods Statement

Declaration

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