Air Source Heat Pump Survey

• Conducted on

  Date

• Prepared by

• Client Name

• Address

• Postcode

• What3Words (Please visit https://what3words.com and get the what3words for this address)

• Property Type

  Flat

  Bungalow

  Semi Detached

  Detached

  Terrace

• Number of Bedrooms

  Select 1 2 3 4 5 6+

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6+

• Age

  Pre-1994

  1994-2007

  Post 2007

• Plans Provided (if yes, please forward via email, including questionnaire)

  Yes

  No

  N/A

Electrical

• Picture of Circuit Breaker

  Media

• Incoming supply

  Media

• Suggested Electrical cable run

  Media

• Location of Meter

  Media

• Existing Heating

  Select Electric Storage Electric Boiler Combination Boiler Boiler & Cylinder ASHP GSHP

  • Electric Storage
  • Electric Boiler
  • Combination Boiler
  • Boiler & Cylinder
  • ASHP
  • GSHP

• Fuel Source

  Select Oil Gas Electric (Single Phase) Electric (3 Phase) LPG Coal Wood

  • Oil
  • Gas
  • Electric (Single Phase)
  • Electric (3 Phase)
  • LPG
  • Coal
  • Wood

• Heat Emmitters

  Radiators

  Underfloor Heating

  Electric Storage

  Other

• Current Boiler Location and Dimensions

  Media

• Current Cylinder Location and Dimensions

  Media

• Number of Bathrooms

New System

• How many days will this install Take

• Preferred manufacturer

• New Cylinder size

• New Cylinder Type

• New cylinder location

• Please explain location of controller in relation to pump, cylinder and fuse box

• Proposed heat pump location

• Any issues regarding placement and condensation? if yes please detail

• Does customer require a quotation with radiator changes?

• Distance of cylinder from pump

• Is Trunking required

  Yes

  No

  N/A

• If yes Please Detail ()

• Placement of contoller Unit(Picture)

  Media

• Type and Size Pipes (Take pictures and draw pipe run and sizes)

• Any material to be ordered?

• Survey Pics

  Media

• Drawings

  Drawing