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wrench-screwdriver
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wrench-screwdriver
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1
Full Name
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First Name
Last Name
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2
Full Address
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3
E-mail
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4
Best Phone Number
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Area Code
Phone Number
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5
Please enter details of requested work and/or description of problem
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6
Picture (if any)
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7
Does anyone in your household have any symptoms of coronavirus?The symptoms being a new continuous cough and/or high temperature.
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8
Is anyone in your household being tested for coronavirus?
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9
Is anyone in your household self-isolating due to potential coronavirus infection?
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10
Has anyone in your household been in contact with someone who has tested positive for coronavirus?
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11
Is there a vulnerable occupier at this property?
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Although there is no legal definition of vulnerable occupier, an occupier is generally considered to be vulnerable if they have a characteristic that means that the issue being raised would have a materially greater negative impact on them than on someone who does not have that characteristic. Examples of such characteristics include: Mental health needs Learning difficulties Aged over 65 years Aged under 16 years Severe physical health problems, debilitating illness or disability The recently bereaved Pregnant women
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12
Signature - I confirm the information is true. -
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13
Please verify that you are human
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14
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