ALG ASSESSMENT SERVICES

• Audit Title

• Conducted on

  Date

• Prepared by

  Lee Gregory

  Peter Cartlidge

• Property Tenure

  Owner Occupied

  Private Tenant

  Social Housing

• Landlord

  Select Taff Housing Association Monmouthshire Housing Association Tai Calon Hafod Housing Association Merthyr Valley Homes Wales & West

  • Taff Housing Association
  • Monmouthshire Housing Association
  • Tai Calon
  • Hafod Housing Association
  • Merthyr Valley Homes
  • Wales & West

• Weather Conditions

Tenant/Homeowner Details

• Name

• Address
  Address

• Phone 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

• CIGA Guarantee Required

  Yes

  No

Property Details

• Property Type

  Select House Bungalow Flat Maisonette

  • House
  • Bungalow
  • Flat
  • Maisonette

• Detachment

  Mid-Terrace

  End terrace

  Semi-detached

  Detached

• Detachment

  Mid-Terrace

  End terrace

  Semi-detached

  Detached

• Flat position

  Ground floor

  Mid floor

  Top floor

• 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 LPG Biomass ASHP GSHP

  • Gas
  • Oil
  • Solid Fuel
  • Electric
  • LPG
  • Biomass
  • ASHP
  • GSHP

• 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

• Insulation Works Required

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

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

• Photo Of Loft

  Media

• Total Loft 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

• Depth to installed

  100mm

  150mm

  200mm

  250mm

  300mm

• Relay Required

  Yes

  No

• Tanks & Pipes need insulating

  Yes

  No

• Loft hatch needing DP/Insulating

  Yes

  No

• Loft Vents Required

  Yes

  No

• Down lights present

  Yes

  No

• How many

• F rated covers required

  Yes

  No

• Walkway required

  Yes

  No

• Cavity Wall Insulation Total Area

• Loft Hatch Photo

  Media

• Floor Type

  Solid Floor

  Suspended Timber Floor

• Required Material

  SIG Carbon +

  Thermabead

  Climabead

  Superbead

• Existing Ventilation present

  Yes

  No

• Type of room ventilation present

  Select Mechanical Extraction Ventilation Passive Stack Ventilation system Bedroom Ventilation Pantry Ventilation Window Trickle Vents Positive Input Ventilation

  • Mechanical Extraction Ventilation
  • Passive Stack Ventilation system
  • Bedroom Ventilation
  • Pantry Ventilation
  • Window Trickle Vents
  • Positive Input Ventilation

• 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

• Borescope Image

  Media

• Cavity depth image

  Media

• Number of cavity brushes required

  1

  2

  4

  0

• Combustion Vent required

  Yes

  No

• Image of appliance

  Media

• Remedial works required

  Yes

  No

• List of 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 Internal plaster to be stripped back, tanked and re-plastered

  • 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
  • Internal plaster to be stripped back, tanked and re-plastered

• To be completed by

  Installing Company

  Client

  Both

• DPC above floor level

  Yes

  No

• Any access issues

  Yes

  No

• Images of access issues

  Media

• 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

  Select Bead White Fibre Yellow Fibre Rockwool Foam

  • Bead
  • White Fibre
  • Yellow Fibre
  • Rockwool
  • Foam

• Recommended cavity drying time

  1 week

  2 weeks

  4 weeks

• Damp reading results

• Moisture reading results

Access

• On site parking

  Excellent

  Good

  Poor

• Reason for poor parking

• Access Equipment Required

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

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

Condensation or Damp Issue

• Issues Identified

Other Property Issues

• Issues Identified

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 if applicable

  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 if applicable

  Sign

• Disclaimer

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

  None

  Previously noted

• Assessors signature

  Sign