Title Page
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Date of Inspection:
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Title
- Mr.
- Mrs.
- Ms.
- Miss.
- Dr.
- Reverend.
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Customer Full Name
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COMF/COLA Scheme Ref No:
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Customer Address
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First Line of Address
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Mobile Telephone No:
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Home Telephone No:
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Alternative Telephone No:
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Email Address
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Best Number to Contact & Time of Day.
- Home - AM
- Home - PM
- Mobile - AM
- Mobile - PM
- Alternative - AM
- Alternative - PM
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Property Tenure
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Leasehold or Freehold
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Landlord Name
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Landlord Address
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Landlord contact Details (phone or email)
Eligibility
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Date Of Birth
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Benefits
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Please List
- Income based jobseekers Allowance (JSA)
- Income related Employment & Support Allowance (ESA)
- Income Support (IS)
- Pension Credit Guarantee Credit (PCGC)
- Working Tax Credit (WTC)
- Child Tax Credit (CTC)
- Universal Credit (UC)
- Housing Benefit (HB)
- Pension Credit Savings Credit (PCSC)
- Child Benefit (subject to income caps & composition)
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Health Conditions
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Please List
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Household Income
- Below - x1 Adult = £36,000
- Below - x1 Adult + x1 Child = £36,000
- Below - x1 Adult + x2 Child = £36,000
- Below - x1 Adult + x3 Child = £36,000
- Below - x1 Adult + x4 Child plus = £40,480
- Below - x2 Adult = £36,000
- Below - x2 Adult + x1 Child = £36,000
- Below - x2 Adult + x2 Child = £37,950
- Below - x2 Adult + x3 Child = £43,643
- Below - x2 Adult + x4 Child pus = £49,335
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Please ask for proof of Income, and record yearly amount.
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No of Adults in Property
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No of Children in Property
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Current EPC Band (if one)
- A
- B
- C
- D
- E
- F
- G
- No EPC on Property
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New EPC band & Score
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Is the property in a Low Super Output Area (LSOA) - "check HUG website if needed" http://www.dorset-hug.co.uk/
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Please add the LSOA post code
Property Info
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Property Type
- Detached House
- Semi-Detached House
- Mid-Terrace House
- End-Terrace House
- Detached Bungalow
- Semi-Detached Bungalow
- Mid-Terrace Bungalow
- Ground Floor Flat
- Mid Floor Flat
- Top Floor Flat
- Maisonette
- Single Park Home
- Double Park Home
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Main Building Age
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Does the property have an Extension
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Extension Age
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Constrution of Extension
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Roof Type of Extension
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Smart Meter Installed
Heating
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Heating System Type
- ESH
- HHR_ESH
- On_peak ERH
- LPG Boiler
- Oil Boiler
- Solid Fuel Boiler (wood/coal)
- Biomass
- Electric Central heating System
- Gas Central Heating
- Gas Room Heaters
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Fuel Type
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Heating Controls in Situ
- No time or thermostat control of room temperature
- Programmer and room thermostat
- Programmer, room thermostat and TRVs
- Programmer, TRVs and bypass
- Programmer, no room thermostat
- TRVs and bypass
- Programmer, TRVs and boiler energy manager
- Programmer and at least two room thermostats
- room thermostat only
- Manual charge control
- Automatic Charge Control
- Appliance control only
- Smart Heating Controls
- Radbots
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Heating Controls Required
- Programmer
- Thermostat
- TRVs
- Smart controls
- Radbots
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Current Annual Electricity Use per year (kwh/£)
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Current Annual Gas Use per year (Kwh/£)
Loft Insulation
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Loft Insulation Less or Equal to 200mm
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Can the loft be accessed easily
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Photo of overall loft area (each corner)
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Photo of loft depth
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Are all ceilings in a good state of repair
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Please identify the areas in question and provide pictures.
Cavity Wall Insulation
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Cavity Wall Insulation required to Main building or Extension
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Main Building or Extension to be insulated
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Photo of each elevation
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Building Condition
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Is DPC visible above 150mm above ground. (if no DPC is visible, add notes & Photos as to why)
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Please Borescope Walls and add photos
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Does the property have Vents
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Which Vents are present
- Under Floor Vents
- Window Trickle Vents
- Room Vents
- Extractor Fan
- Combustion Vent
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Are there any Access Issues - if yes please evidence
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Does the property have any Party Walls
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Can the construction of the Party Wall be identified from the loft space
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Construction type
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Can party wall insulation be installed if neighbouring property agrees.
Park Homes - Please advise that not all measure may be achievable
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Client Interested in Park home Insulation
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Is Park Home Double or Single unit
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Photo of each Elevation of the Park Home
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Will all elements of the Park Home require insulation
- Walls
- Floor
- Roof
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What is the condition of the walls
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What is the condition of the external Ply Skin
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is there any existing wall Insulation
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Remedial Works required on external walls prior to instal
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Is there access to the Floor
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is there existing insulation.
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Please select the Floor joints present
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Is there access to the roof
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is there any existing insulation
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Are there any metal rafters
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what is the Roof verge overhang (mm)
Solar PV
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Client Interested in Solar PV
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Client comfortable using mobile wireless app to monitor panel output
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Roof Type
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Height of Roof from Ground
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Pitch of Roof Orientation
- North
- East
- South
- West
- North-East
- South-East
- North-West
- South-West
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Pitch of Roof (Elevation in Degree º)
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Roof Material
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Dorma Windows Present
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Any Over-Shading
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Any Access Issues. (scaffolding/parking)
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Photo of all Roof Elevations
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Photo of Tile Type (close up)
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Photo of Current Electrical System/Board
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Photo of Potential Space in Loft for Invertor
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Photo Inside Loft to show (roof struts/purlins/joists/rafters)
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Any other useful photos
Air Source Heat Pump - (GFF,Terrace, or 2 bed home only + Alongside BUS Grant) https://www.ofgem.gov.uk/environmental-and-social-schemes/boiler-upgrade-scheme-bus/property-owners
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Client interested in Air Source Heat Pump
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Do they have the space for the outside HP unit? (Typical dimensions W 1000mm x H 1000mm x D 600mm.includes clearance required in front of unit.)
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Can the HP Unit be housed 1 meter away from any boundaries or neighbouring properties
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Do they have space for the hot water tank? (Typical dimensions W 1000mm x H 2000mm x D 700mm)
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Photo of possible Location
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Do they have space for the Internal heat exchanger, where required? (W 500mm x H 800mm x D 350mm)
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Is there space below it to ground level for the pressure vessel & pipework? (although often these are in a loft space so less of an issue (On Smaller heat demand systems could use a "Monoblock" system that have all the heat exchanger parts in the outside unit.
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Do they have radiators at present and if so, are they on standard pipework?
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Photo of Radiators
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Micro-boro pipe work not possible under scheme
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Would the resident require extra help in setting heating controls after install?
HHR Storage Heaters
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HHR Storage Heaters required
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Does the Property have a Ecom-7 Supply
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Photo of Electric Meter
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Can meter be changed
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Number of Pre-existing Heaters
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Number of HHR ESH to be installed into the property
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Will the new HHR ESH heat 100% of the Property
Other Measures
Solid Wall Insulation
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Solid Wall Insulation
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Photo of Each Elevation
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Building Condition
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is it a system build fabric
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Photo of DPC
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Does the Property have any Vents
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Which vents are present
- Under Floor Vents
- Window Trickle Vents
- Room Vents
- Extractor Fan
- Combustion Vent
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access Issues
Room In Roof Insulation
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Does Property have qualifying RIR
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Number of rooms in RIR area
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Is there access to Residual Areas
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Which areas require Insulating
- Pitched Roof/Loft
- Flat Dormer Roofer
- Dormer Walls
- Sloping Ceilings
- Stud/Dwarf Walls
- Gable/Party Walls
Flat Roof Insulation
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Flat Roof
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Flat Roof m2
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Flat roof Insulated
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Photo of Flat Roof (from above & ground level)
Solar Thermal
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Client Interested in Solar Thermal
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Client comfortable using mobile wireless app to monitor panel output
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Roof Type
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Height of Roof from Ground
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Pitch of Roof Orientation
- North
- East
- South
- West
- North-East
- South-East
- North-West
- South-West
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Roof Material
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Dorma Windows Present
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Any Over-Shading
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Any Access Issues. (scaffolding/parking)
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Photo of all Roof Elevations
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Photo of Tile Type (close up)
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Photo Inside Loft to show (roof struts/purlins/joists/rafters)
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Any other useful photos
Under Floor Insulation
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Under Floor Insulation required
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Is there Access to the Under Floor
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Is there a minimum depth of 1 meter below the floor
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Is there adequate cross flow ventilation below the floor
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Can Access be made easily
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Is there a minimum of 1 meter access below the floor
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Is there adequate cross flow ventilation below the floor
Low Energy Lighting
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LED light Bulbs Required
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How Bulbs to be fitted & Fitting Required
Hot Water Tank Insulation
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Hot Water Tank present
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Dose that Hot Water Tank require new insulation jacket
Draught Proofing
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Draught Proofing Required
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Number of Doors to be Draught Proofed
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Number of Windows to be Draught Proofed
Conclusion
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Evidence on Eligibility Checked
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COMF/COLA leave behind notice given to client
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CUSTOMER SIGNATURE - (PLEASE READ) - I can confirm that I have given consent for my qualifying evidence to be viewed by the assessor at the time of there visit, I have received relevant Data Protection & GDPR documents. and all other procedures that are required following there visit have been explained to me regarding further visits and installations.
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Survey Completed By