Title Page
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Name of Surveyor
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Site Address
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Tenant name
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Customer Contact Number
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Contract/Client
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Installation type
- Combi boiler chg
- Upgrade from heat/system boiler to combi
- Upgrade from BBU to combi
- Full install
- Radiators only
- Pipework and rads
- Not required
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Property type
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Door code if void or access notes
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Type of installation Existing
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Old boiler, Tanks and cylinder to be removed?
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Boiler type required
- Worcester 4000 30KW
- Worcester 4000 25KW
- Worcester system 12KW
- Worcester system 15KW
- Worcester system 18KW
- Worcester system 21KW
- Worcester system 24KW
- Worcester H/O 15KW
- Vaillant Sustain 28kw
- Vaillant Sustain 24kw
- Vaillant Ecotec pro 28kw
- Vaillant Ecotec pro 24kw
- Boiler not required
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Please take pictures of proposed new boiler location.
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Please take picture of Existing Flue. Inside & Externally
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Flue type required
- Standard
- Long standard
- Vertical flue, 3 ext plus 45 bends
- Vertical flue, 2 ext plus 45 bends
- Vertical flue, 1 ext plus 45 bends
- Standard flue with plume kit
- Not required
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Worcester simple link flue adapter
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Flue accessorys
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Controls pack required
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Details of condense discharge
- Internal to sink/Basin waste up to 3 meters
- Internal to sink/Basin waste over 3 meters
- External waste to drain up to 3 meters
- External waste to drain over 3 meters
- Existing okay
- Existing okay but needs external lagging 3 meters
- Existing okay but needs external lagging 6 meters
- Existing okay but needs external lagging 9 meters
- Not required
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Condense notes or special materials
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Gas run in meters if required
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Replace lead tail on gas meter
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TRVs required
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Lock shield valves required
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Size of radiator valves required?
- 8mm
- 10mm
- 15mm
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Please list sizes of any radiators that need to be replaced and which rooms they are situated in?
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Additional materials
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Is scaffolding required?
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If scaffolding required please take photos of position
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Stop tap working
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Is electrician required day of install
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Please select electrical parts requirements
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Customers actions required IE empty airing cupboard...
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Customer actions signiture
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Additional notes
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Recommendations of work required
- Boiler change only
- Boiler change with replacement of radiators
- Full central heating install
- Remove heat only/BBU/Wall mounted boiler and upgrade to a combi boiler
- Replace radiators only
- Remove and refit radiators to allow for kitchen/Bathroom works
- Other work please describe
- No work required
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Any asbestos concerns ?
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Property condition
- Very good
- Good
- Fair
- Poor
- Requires attention before an engineer can work in
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Please log any builder work required here
