Basic Survey Questionnaire

• Conducted on

  Date

• Have you completed a POWRA?

  Yes

  No

• Do not proceed until POWRA is completed

• Prepared by

• Location
  Address

• Site name

• Brief description of building

• Is the exterior of the building in good condition

  Yes

  No

• Describe faults

• Provide photographs

• Are the windows

  Select Single Glazed Double Glazed Triple Glazed Other

  • Single Glazed
  • Double Glazed
  • Triple Glazed
  • Other

• Are they airtight and in good condition

  Yes

  No

• Please describe faults

• Please provide Photos

  Media

• Are exterior doors in good condition?

  Yes

  No

• Are they

  Select Single Glazed Double Glazed Triple Glazed Other

  • Single Glazed
  • Double Glazed
  • Triple Glazed
  • Other

• Please provide photos

  Media

Lighting

• What lighting is used on site

  Select LED CFL Fluorescent Halogen Other

  • LED
  • CFL
  • Fluorescent
  • Halogen
  • Other

• Number and location

• Please add photographs

  Media

• What energy reduction measures are suitable?

Lighting Controls

• Are there lighting controls

  Select Presence Detection Manual Switching Daylight Dimming

  • Presence Detection
  • Manual Switching
  • Daylight Dimming

• Please add photographs

  Media

• What energy reduction measures are suitable?

• How is the building heated

  Select Electric Panel Heaters Radiators (Wet System) Air Conditioning Central Plant (AHU)

  • Electric Panel Heaters
  • Radiators (Wet System)
  • Air Conditioning
  • Central Plant (AHU)

• Description of system

• Please add photographs including manufacturers plates if possible

  Media

• What energy reduction measures are suitable?

Hot Water

• How is hot water produced

  Select Point of Use Heaters From Boilers From CHP Other

  • Point of Use Heaters
  • From Boilers
  • From CHP
  • Other

• Please add photographs

  Media

• Please add photographs of manufacturers details, plant size, any metering, buffer tanks etc.

  Media

• What is the temperature of the circulated water

• What energy reduction measures are suitable?

• Please list other pieces of significant plant

• Please add photographs

  Media

• Is there a BMS on site

  Yes

  No

• Please provide description of system

• Please provide photos

  Media

• What energy reduction measures are suitable?

• Please indicate what utility meters are on site

  Select Electricity HH Electricity NHH Gas Water

  • Electricity HH
  • Electricity NHH
  • Gas
  • Water

• Please provide photographs of all meters

  Media

• Are there any Sub-Meters on site

  Yes

  No

• Is the data collected on site by BMS or similar

  Yes

  No

• Please provide photographs

  Media

• Is water metered

  Yes

  No

• Please photograph water meter

  Media

• Measure flow from taps and shower heads

• What energy reduction measures are suitable?

• Does the site have any renewable or low carbon technologies?

  Select Solar PV Solar Thermal Wind Biomass Boiler Biomass CHP None

  • Solar PV
  • Solar Thermal
  • Wind
  • Biomass Boiler
  • Biomass CHP
  • None

• What renewable opportunities are there?

  Select Solar PV Solar Thermal Wind Biomass Boiler Biomass CHP None

  • Solar PV
  • Solar Thermal
  • Wind
  • Biomass Boiler
  • Biomass CHP
  • None

• What is the area available

• Please provide photographs

  Media

• Is there sufficient area for fuel storage

  Yes

  No

• Please add photographs

  Media

• Is there sufficient space to install a wind turbine?

  Yes

  No

• Please add photographs

  Media

• Does the building have a current EPC

  Yes

  No

• Please upload copy of EPC and Advisory Report to file from https://www.ndepcregister.com/

• Does the building have installed Air Conditioning >12kW

  Yes

  No

• Is the system > 5 years old

  Yes

  No

• Is there a current TM44 report available

  Yes

  No

• Upload copy of certificate and report to file from https://www.ndepcregister.com/

• Does the building require a Display Energy Certificate?

  Yes

  No

• Is a current DEC displayed in a prominent place, full colour and A3 in size

  Yes

  No

• Upload copy of certificate and report to file from https://www.ndepcregister.com/

• Any other site information or opportunities

  Yes

  No

• Describe other opportunities

• Please add photographs

  Media