ALG ASSESSMENT SERVICES

• Audit Title

• Conducted on

  Date

• Prepared by

Tenant/Homeowner Details

• Name

• Address
  Address

• Phone Number

• Mobile Number

• Email Address

• Preferred Time of Contact

  Select Morning Afternoon Evening Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Morning
  • Afternoon
  • Evening
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

• Preferred Contact Method

  Select Landline Mobile Email Letter

  • Landline
  • Mobile
  • Email
  • Letter

Installing Company Details

• CIGA Guarantee Required

  Yes

  No

• Company Name

  Propoint-UK

  Evolve HES

• Company Address

  Select 3 Y Graig, Llantrisant, CF72 8FB WYASTONE BUSINESS PARK, MONMOUTH, NP25 3SR

  • 3 Y Graig, Llantrisant, CF72 8FB
  • WYASTONE BUSINESS PARK, MONMOUTH, NP25 3SR

• Phone Number

  0800 240 4634

  01600 887551

• Email Address

  MARIA@PROPOINT-UK.CO.UK

  INFO@EVOLVEHES.CO.UK

Property Details

• Property Type

  Select Mid-Terrace End terrace Semi-detached Detached Lower Flat Middle Flat Top Flat Maisonette Other

  • Mid-Terrace
  • End terrace
  • Semi-detached
  • Detached
  • Lower Flat
  • Middle Flat
  • Top Flat
  • Maisonette
  • Other

• Building finish

  Select Brick Cotswold Stone Render Pebble Dash

  • Brick
  • Cotswold Stone
  • Render
  • Pebble Dash

• Number of Bedrooms

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Main Heating Type

  Select Gas Oil Solid Fuel Electric Other

  • Gas
  • Oil
  • Solid Fuel
  • Electric
  • Other

• Insulation Works Required

  Select Loft Insulation Cavity Wall Insulation Draught Proofing Extraction Underfloor Insulation Internal Wall Insulation Ventilation External Wall Insulation Party Wall Insulation

  • Loft Insulation
  • Cavity Wall Insulation
  • Draught Proofing
  • Extraction
  • Underfloor Insulation
  • Internal Wall Insulation
  • Ventilation
  • External Wall Insulation
  • Party Wall Insulation

• Structural condition

  Safe

  At Risk

  N/A

• External Wall Condition

  Sound

  Un-sound

• Adequate ventilation to work area

  Yes

  No

  N/A

• Any evidence of dampness or water damage?

  Yes

  No

• Photo of each elevation

  Media

• Special Instructions

Access

• On site parking

• Access Issues

  Yes

  No

• Access Equipment Required

  Select None Ladders Tower Scaffolding Cherry Picker Scissor lift Spider Conservatory Ladder

  • None
  • Ladders
  • Tower
  • Scaffolding
  • Cherry Picker
  • Scissor lift
  • Spider
  • Conservatory Ladder

Details

• Total area to be insulated

• Loft Space/hatch photo

  Media

• Floor Type?

  Solid Floor

  Suspended Timber Floor

• Existing room ventilation present?

  Yes

  No

• Type of room ventilation present?

  Select Mechanical Extraction Passive Ventilation system Bedroom Ventilation Pantry Ventilation Window Trickle Vents

  • Mechanical Extraction
  • Passive Ventilation system
  • Bedroom Ventilation
  • Pantry Ventilation
  • Window Trickle Vents

• Required material

  SIG Carbon +

  Thermabead

  Climabead

  Superbead

• Average Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Boroscope photo

  Media

• Cavity Depth Photo

  Media

• Number of Cavity brushes required

  1

  2

  4

  0

• Combustion vent required?

  Yes

  No

  N/A

• Photo of appliance requiring combustion vent

  Media

• Any Remedial Works Required before installation?

  Yes

  No

• List All Remedial Works Required

  Select Gutter Clearance Required French drain required Render Cracks to be sealed Spalled brickwork to be replaced Chemical Damp course to be injected Climbing plants to be removed Re-pointing of mortar beds required Render to floor to be bellcasted

  • Gutter Clearance Required
  • French drain required
  • Render Cracks to be sealed
  • Spalled brickwork to be replaced
  • Chemical Damp course to be injected
  • Climbing plants to be removed
  • Re-pointing of mortar beds required
  • Render to floor to be bellcasted

• Images identifying remediation work required

  Media

• Remedial Work to be completed by?

  Select Installing Company Client Both

  • Installing Company
  • Client
  • Both

• Photo of access issues

  Media

• Chimneys Present?

  Select Yes No

  • Yes
  • No

• Location of Chimneys

  Select Internal External Front Elevation Rear Elevation Left Hand Elevation Right Hand Elevation None

  • Internal
  • External
  • Front Elevation
  • Rear Elevation
  • Left Hand Elevation
  • Right Hand Elevation
  • None

• DPC minimum 150mm above floor level?

  Yes

  No

• Total area to be extracted

• Reason for extraction

  Select Voids identified in insulation leading to cold bridging Saturated Insulation causing internal Damp issues Timber Framed property not suitable for retro-fit insulation Steel Framed property not suitable for retro-fit insulation Areas of rubble identified within the cavity Wall tie failure

  • Voids identified in insulation leading to cold bridging
  • Saturated Insulation causing internal Damp issues
  • Timber Framed property not suitable for retro-fit insulation
  • Steel Framed property not suitable for retro-fit insulation
  • Areas of rubble identified within the cavity
  • Wall tie failure

• Material being extracted

  Bead

  White Fibre

  Yellow Fibre

  Rockwool

  Foam

• Recommended cavity drying time

  1 week

  2 weeks

  4 weeks

• Are all apertures sealed internally

  Yes

  No

• Moisture reading results

• Has client been advised on extent of drilling and core holes?

  Yes

  No

  N/A

• Photo of loft

  Media

• Area to be insulated

• Existing Depth

  Select 0mm 50mm 70mm 100mm 150mm 200mm 250mm 270mm 300mm

  • 0mm
  • 50mm
  • 70mm
  • 100mm
  • 150mm
  • 200mm
  • 250mm
  • 270mm
  • 300mm

• Photo of existing depth

  Media

• Depth to be added

  100mm

  150mm

  200mm

  250mm

  300mm

• Loft drawing

  Drawing

• Relay Required

  Yes

  No

• Please note any pipe work that required lagging

• Loft hatch needing DP/Insulating?

  Yes

  No

• Loft vents required

  Yes

  No

• Areas to be omitted

  Yes

  No

• Walkway required

  Yes

  No

• Loft clearance

  Yes

  No

• Additional notes

Condensation or Damp Issue

• Add media

  Media

Other Property Issues

• Add media

  Media

Dynamic Risk Assessment

• I confirm that I have explained to the customer the reason for and remediation action required regarding the items recorded in the CWI section to ensure the suitability of the property to receive cavity wall insulation.

  Yes

  No

  N/A

• Assessors Signature

  Sign

• I confirm I have received a full explanation and understand the remediation actions needed to complete prior to installation of cavity wall insulation.

  Yes

  No

  N/A

• Client Signature

  Sign

• I have assessed the conditions on site ensuring there is adequate ventilation and no evidence of damp or excessive condensation issues. Unless listed below, there are no additional significant hazards observed that are not addressed in the generic risk assessment for the work to be undertaken.

  None

  See Below

• Assessors signature

  Sign

• Client signature

  Sign