Planned and Programmed works

Latest revision date: May 2023
Revisions due date: May 2025


Who is this form for?

Use this form if you are waiting for Berneslai Homes to complete any outstanding works to your home (either planned repair or a programmed replacement).
Please let us know if the situation has significantly changed, for example if the item to be repaired or replaced is becoming a Health and Safety risk. Please give us as much detail as possible and we will use this when scheduling works.

Protecting your personal data

By completing this form you acknowledge that we will follow our responsibilities under data protection legislation. We will store the information securely, share it with partners and other statutory agencies where we have the right under law to do this, use it only for the purpose it was provided and process it as set out in our privacy policy. For more information please see our privacy policy on our website
  • Your Details

  • Title *

  • First Name *

  • Last Name *

  • Address *

  • Phone Number *

  • Email Address *

  • What has Changed?

  • What has changed? *

    Please describe how the situation has changed. You can also attach any photographs that might highlight the issue in the ‘upload’ section below. (text box)

  • Details about people living in your home?

  • How many people are living in the property? *

  • Are there any babies in your household? *

  • Are there any children in your household? *

  • Are there any people over 65 in your household? *

  • Are there any resident in your home with any disabilities or health conditions? *

  • Please provide further information *

  • Upload
  • To upload this information you can either use a scanner or take a photo with your phone or tablet. Just click the upload button.
    More than one piece of information? Just click the “Add” button after you’ve finished uploading each one. You can upload a maximum of five pieces of evidence.

  • Upload Documents

    You can upload the following file types: JPG, PDF, PNG
    Please note if you are going to save this form instead of submitting, you will need to upload your file when you submit.

  • Confirmation
  • By ticking the box below, I declare that I fully understand and agree with the following statements:

    - I declare that the information I have given on this form is correct and complete. 

    - I understand that if I have not completed this form fully it may result in a delay in us acting on your request.