Demolition and Dismantling · Suppliers of Reclaimed Materials and Recycled Aggregates (t) 01942 813188 · (f) 01942 814039 · (e) enquiries@forshawdemolition.co.uk · (w) www.forshawdemolition.co.uk

Licensed Waste Carriers Reg No: NSO/543914 · Registered in England: 594000 · VAT Reg No: 146 1053 96Directors: Mr. A.J.Forshaw BA Hons(Dunelm), Mrs. K.L.F.Jones, Mr.C.Forshaw BA Hons

Blowdown questionnaire for residents located within the exclusion zone for the explosive demolition of Queens Park Flats. Blowdown date – Sunday 15th May 2016.

Name:

Address:

Flat/House Number &

Street name only

Preferred Contact No:

Number of people in the house

Adults Children Children under 3

Special needs of residents Housebound Disabled Wheelchair

Any other special or medical needs

Special dietary requirements

On the day the WFL will be making available an evacuation facility venue tbc. Food to suit all dietary needs and refreshments will be provided on the day.

Will you be making your own arrangements on the day or will you be using the respite area:

Own Respite Area

How are you getting to the respite area Own Need transport

Will you require high chair, baby changing and feeding facilities YES NO

Do you have any pets that will require special attention on blowdown day.

(including dogs/cats/fishponds/hens/birds/etc)

YES (type & quantity of pets)

No Pets