DASH-EMS | Pre-Survey Site Assessment & Quote Request

1 Client Information

Company Name *

Branch / Site Name *

Full Physical Address of Site *

Contact Person on Site *

Contact Phone *

Contact Email

2 Site Size Assessment

Both headcount and site area help us determine the correct survey scope. Please provide both if possible.

👥 Total Employees on Site

Include all shifts, contractors & visitors on a typical day

📏 Approximate Site Area (m²)

Total floor area including warehouses, workshops, offices

Number of Floors / Levels

ℹ️ Why do we ask for site area?
A warehouse with 20 employees but 5,000 m² requires the same survey effort as a 100-person office. Both headcount and site size help us scope the assessment accurately.

3 Surveys Required

Select all surveys you require. Items marked LAB may attract additional laboratory analysis costs.

Physical Agents

🔊 Noise Survey 💡 Illumination Survey 🌬️ Indoor Air Quality 🪑 Ergonomics Assessment 🌡️ Heat Stress (WBGT) 🧊 Cold Stress 📢 Interior Acoustics 🌀 Ventilation (LEV)

Chemical & Biological Agents

⚗️ HCA Risk Assessment 🧪 HCA Exposure Monitoring LAB 💨 Dust Exposure LAB 🧱 Asbestos Assessment LAB 🔋 Lead Survey LAB 🧯 Chemical Storage & Compatibility

Environmental & Risk

🏥 OH Risk Assessment 📢 Environmental Noise 🌍 Environmental Pollution RA

Water Quality

☣️ Legionella Sampling LAB 💧 Potable Water Analysis LAB 💧 Water Risk Assessment

4 Site Operations & Details

Describe your main operations / activities *

This helps us confirm you've selected the correct surveys

List departments / areas on site

Chemicals used on site (if any)

If you use chemicals, you likely need the HCA survey — we will confirm

Operating hours

Number of shifts

5 Additional Information

Any special access requirements?

Previous surveys done? (If yes, when?)

Anything else we should know?

📋 Pro-Forma Quotation

⚠️ Pro-Forma Estimate Only: This is an indicative quotation based on the information provided. An official quotation will be issued by a registered occupational hygienist after reviewing your site details. Final pricing may vary based on the number of sampling points, laboratory analysis requirements, site complexity, and travel distance.

Survey / Assessment	Amount (excl. VAT)

Estimated Total (excl. VAT) R 0.00

VAT (15%): R 0.00

Total incl. VAT: R 0.00

Conditions:
1. All prices are exclusive of VAT (15%) unless stated otherwise.
2. Surveys marked with LAB may attract additional laboratory analysis costs depending on the number of samples required. These will be confirmed in the official quotation.
3. Site size classification is based on the higher of headcount OR site area tier.
4. Travel costs for sites outside Gauteng, Western Cape, or KZN metro areas will be quoted separately.
5. Reports are delivered within 5–10 working days from date of survey.
6. All surveys are conducted by a SAIOH registered occupational hygienist under SANAS accreditation OH0238.
7. This pro-forma estimate is valid for 30 days. An official quotation will follow after review by the hygienist.

By submitting this form, you confirm the information is accurate. DASH-EMS will review your submission and issue an official quotation within 24 hours.

A DASH-EMS consultant will contact you within 24 hours.