Domestic Heating Installation Survey

• Job No.

• Attended By

  BTU

  DLO

• Full Name of Surveyor

PROPERTY DETAILS

• Date

  Date

• Calling Card Left (Insert Time and Date) provide evidence of card being left

  Media

• JOB NUMBER

• Occupants Name

• Address
  Address

SAFETY INFORMATION

• Start Time?

  Date

• Has an Asbestos Survey been conducted at the property and available to view?

  YES

  NO

  UNKNOWN

• If "No" or "Unknown" contact line manager to see whether to continue with the survey

• Any special customer requirements?

  Select Unsuitable Times Restrictions Special Needs Noise Restrictions Pets Other

  • Unsuitable Times
  • Restrictions
  • Special Needs
  • Noise Restrictions
  • Pets
  • Other

• If any of above chosen state more information

• Risk Assessment

Hazards Present

• What are the Hazards?

  Select Falls from Ladders, Scaffolding Etc Risk to eyes when drilling Etc Electric Shock Asbestos within a work area General Site Hazards Visitors entering area

  • Falls from Ladders, Scaffolding Etc
  • Risk to eyes when drilling Etc
  • Electric Shock
  • Asbestos within a work area
  • General Site Hazards
  • Visitors entering area

• Who Might Be Harmed?

  Select Staff Contractors Site Visitors

  • Staff
  • Contractors
  • Site Visitors

• What is currently in place to prevent this?

  Yes

  No

  N/A

• Do you need to anything else to prevent this Risk?

  Yes

  No

  N/A

• Action by whom

  Select All Employees All Sub Contractors

  • All Employees
  • All Sub Contractors

• Action by When?

  Completed

  1 Week

  1 Month

  6 Months

  12 Months

• Who Might be Harmed?

  Select Staff Contractors Site Visitors

  • Staff
  • Contractors
  • Site Visitors

• What is currently in place to prevent this?

  Yes

  No

  N/A

• Do you need anything else to prevent this risk.

  Yes

  No

  N/A

• Action by When?

  Completed

  1 Week

  1 Month

  6 Months

  12 Months

• Action by whom?

  Select All Employees All Sub Contractors

  • All Employees
  • All Sub Contractors

TECHNICAL SURVEY

Technical Survey

• Type of Property

  Bungalow

  Flat / Maisonette

  House

• Property Configuration?

  Select Detached Semi Detached Mid Terrace End Terrace Ground Floor Upper Floor

  • Detached
  • Semi Detached
  • Mid Terrace
  • End Terrace
  • Ground Floor
  • Upper Floor

• Water Bonding Present?

  YES

  NO

  UNKNOWN

• Where "UNKNOWN" state more Information here.

• Image of Water Bonding

  Media

• Gas Bonding Present

  YES

  NO

  UNKNOWN

• Where "UNKOWN" state more information here.

• Image of Gas Bonding

  Media

• Main Earth Bonding Bonding Present?

  YES

  NO

  UNKNOWN

• Where "UNKOWN" state more information here.

• If possible please state type of Earth system present

  TT - Earth Spike

  TNCS - Combined N & E

  TNS - Separate Earth

• Image of main Earth Bonding

  Media

• RCD protection present?

  YES

  NO

• Please Note where a TT Earthing system has been selected above please also state here if no RCD Present?

• Photo of Fuse Board

  Media

• Has the property got a GAS Supply?

  YES

  NO

• Gas Pipe size at the Gas Meter?

  22MM

  15MM

  OTHER

• Location of GAS Meter?

• Existing Boiler Manufacturer & Model of Boiler?

• Location of Existing Boiler?

• Photo of Boiler

  Media

• Photo of boiler data plate

  Media

• What is is existing FLUE Type?

  Balanced

  Vertical

  Horizontal

  Fan

• Photo of Flue

  Media

• Photo of New Flue location

  Media

• Please state the boiler FAULT/S

• Estimated Cost of repair (£)

• Location of Stop tap?

• Type of Existing System?

  Select S or Y Plan Combi Condensing Combi Gravity BBU Other

  • S or Y Plan
  • Combi
  • Condensing Combi
  • Gravity
  • BBU
  • Other

• If "OTHER" Please state type of system

• Are there any building works required to the existing system if so please state?

• What materials are required to complete the building works stated above?

  Select Breeze Blocks Red Bricks Buff Bricks Other see photo

  • Breeze Blocks
  • Red Bricks
  • Buff Bricks
  • Other see photo

• Photo of brick colour for best brick match

  Media

• What is the pipe fabric & size to the existing radiators?

  Select Copper Plastic 15MM 10MM 8MM Other

  • Copper
  • Plastic
  • 15MM
  • 10MM
  • 8MM
  • Other

• Do any of the existing Radiators need replacing?

  YES

  NO

• Would the property require installation of a NEW Radiator & Pipe work?

  YES

  NO

• What are the floor structures DOWNSTAIRS?

  Select Wooden Boards Chipboard Solid

  • Wooden Boards
  • Chipboard
  • Solid

• What are the floor structures UPSTAIRS?

  Select Wooden Boards Chipboard Solid

  • Wooden Boards
  • Chipboard
  • Solid

• Please state any obstructions - eg Laminate Flooring in master bedroom

• How many HOT Water outlets are there?

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

• Are there any showers at the property, if Yes what Type?<br>

  NO

  Electric

  Pumped Electric

  Gravity

  Pressurised

• What is the water flow rate at the kitchen sink? (L/M)

• NEW SYSTEM INFORMATION

• What type of Installation will this property require?

  Swap

  Conversion

  Full System

• Size of proposed new boiler

  Select 12KW CONVENTIONAL 15KW CONVENTIONAL 18KW CONVENTIONAL 24KW COMBI 28KW COMBI 35KW COMBI

  • 12KW CONVENTIONAL
  • 15KW CONVENTIONAL
  • 18KW CONVENTIONAL
  • 24KW COMBI
  • 28KW COMBI
  • 35KW COMBI

• Location of NEW Boiler?

• Flue Type Required?

  Balanced

  Vertical

  Horizontal

  Fan

• What Type Condensate Installation is required?

  Bossed Internal

  Bossed External

  External Drain

  Soak Away

  Pumped

• What Heating Controls are Required?

  RF Programmable Stat

  Hard Wired Stat

  Full Plan Pack

• Where is the cylinder located?

  Cylinder Cupboard

  Loft

  Other

  N/A

• If "OTHER" state location

• Photos of Cylinder cupboard showing all controls

  Media

• State if you can think of any reason that this cylinder could not be removed from the property?

• Please add any additional information here that will assist the Plumbing engineer & or the Electrical Engineer with the Installation of the new heating system

• Additional Photos

  Media

• Finish Time?

  Date

MATERIALS LIST

• IF USING PAPER VERSION OF KIT LIST ADD CLEAR PHOTO OF ALL PAGES
  

• Photos of Material Kit list

  Media

• Materials List
  

Materials List

• Type of Boiler?

  Select 12KW CONVENTIONAL 15KW CONVENTIONAL 18KW CONVENTIONAL 24KW COMBI 28KW COMBI 35KW COMBI

  • 12KW CONVENTIONAL
  • 15KW CONVENTIONAL
  • 18KW CONVENTIONAL
  • 24KW COMBI
  • 28KW COMBI
  • 35KW COMBI

• Horizontal Flue

  YES

  NO

• Vertical Flue Terminal?

  YES

  NO

• PLEASE NOTE WHERE A VERTICAL FLUE IS REQUIRED RELEVANT RISK ASSESSMENT TO IMPLIMENTED
  

• Weather Slate

  YES

  NO

• 1M FLUE EXTENSION

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

• FLUE 90 DEGREE BEND

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

• FLUE 45 DEGREE BEND

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

• FLUE SUPPORT CLAMP

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

OCCUPANT SIGN OFF

• Print and Sign (Occupant)

  Sign

• Print and Sign (Engineer)

  Sign