Information
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Customer name
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Customers Address
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Job Number
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Conducted on
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H.S.A name
Survey checks
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Type of installation?
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Is there any Asbestos present in the property
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Is a sample required?
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Has the Socket and See passed?
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Socket and See readings
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Is there a visible main earth
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Is the existing shower compatible?
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Has the mains water pressure been tested?
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Flow rate & time of test
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Has the customer been advised of one tap operation?
Installation type & Boiler
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What boiler is being installed?
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Will boiler clearances met?
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Add media
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Notes on boiler
Flue
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Type of Flue?
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Is 125mm flue required?
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Number of elbows and extensions?
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Have all flue clearances been checked?
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Is an internal fix required?
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Is a terminal guard required?
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Is a plume kit required
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What plume extensions and elbows are required?
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Has pluming been explained to the customer?
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Flue
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Notes on flue
Condense
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Where is the condense terminating?
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If external what colour pipe is required?
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Is a soak away required?
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Is a condense pump required?
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Is the condense terminating into a foul drain?
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Notes on condense route
System Design
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Is the cold feed and open vent configured correctly?
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Does the system need to be sealed?
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Is the system fully pumped?
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Does the customer want new radiator valves?
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Are we changing or adding any radiators?
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If yes what size and location of radiators?
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Has an auto bypass been fitted?
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Are we replacing any existing components?
- 2 port valves
- 3 port valve
- pump
- auto bypass
- Secondary Pump
- N/A
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What type of cylinder are we fitting?
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System
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System notes
Gas pipework
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Is a new gas run required?
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Size of pipework for gas run?
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Notes on gas run
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Photo of gas meter
Water pipework
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Hot and cold supply notes
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Heating pipework notes
System Controls
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What thermostat does the customer want?
- Room Thermostat
- Wireless Roomstat
- Wireless Prog Roomstat
- Hive
- Use Existing
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What time control does the customer want?
- Digital (UP2/UT2)
- Mechanical (EM2/EMT2)
- Integral Mechanical Clock
- Hive
- Wireless Programmable
- Use Existing
- 3 Channel Programmer
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Does the cylinder stat need replacing?
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Does the system need frost protection?
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Notes on system controls
Powerflush and system performance
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Has the customer had any issues with the system?
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Does the system require a power Flush?
Building work, Manual Handling & Working at Heights
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Does the installation require scaffolding?
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What size scaffolding is required?
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Scaffold Location
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Notes on Scaffolding
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Is Specialist Building work required?
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How many specialist build hours required?
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Specialist building work
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Notes on specialist building work
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Is a double handed lift required?
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Is there restricted access?
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Is loft boarding and lighting required?
Electrical
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Is a new fused spur required?
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Does the boiler require a pump over run?
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Is there PEB at all services?
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Notes on electrics
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Photo of fuse board
Disconnect and remove
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What are we removing?
- Boiler
- Cylinder
- F&E Tank
- Cold Water Storage Tank
- Radiators
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Are we disconnecting anything and leaving it in place?
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Notes on removals
Extras
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What extras does the customer want?
- Shower
- Secondary Circulating Pump
- New CWS Tank
- New F&E Tank
- Magnetic Filter
- Hydroflow
- Combisave
- N/A
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Notes on extras
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Is route clearance required?
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Other Notes/Disruption
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H.S.A Signature
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Customer Signature