ECO4 & GBIS Post Installation Customer and Installer Declaration Form Draft Version 0.1

• Property Address

• Conducted on

  Date

• Prepared by

Introduction

• The purpose of this form is to capture the details of the completed project and the measure/s
  within it. The form may be completed offsite when work has completed, and a copy must be
  retained with the occupier.
  Any fraudulent activity including falsifying statements, falsifying signatures, and copying- pasting
  may be reported to the Police/Action Fraud or a similar organisation. This may affect the validity
  of any measure installed and the measure may be rejected.
  Any evidence of electronically duplicated or forged signatures will be investigated. Any measures
  where suspected fraudulent activity or scheme abuse is detected will be rejected1
  .
  Ofgem also recommends that any additional evidence collected as part of these forms be handled
  as the final step in the process to adhere to Data Protection Act 2018 requirements2
  .
  For better understanding on how your data will be used under The Great British Insulation Scheme
  or ECO4 please visit our website3
  .
  Please be aware some sections are scheme specific – and have been labelled as so. If a section
  or question is not relevant to your scheme, please leave section blank. Otherwise, please fill out
  all questions.

• 1 Please see chapter 8 in the ECO4 Delivery Guidance for further information.
  2 https://ico.org.uk/for-organisations/uk-gdpr-guidance-and-resources
  3 https://www.ofgem.gov.uk/environmental-and-social-schemes/great-british-insulation-scheme,
  https://www.ofgem.gov.uk/publications/eco-privacy-notice

Completing the post installation declaration form

• Section A

• This section is designed to capture the details of the occupier or landlord. It must be signed by the occupier or landlord, unless the property is social housing.

• Section B

• This section is designed to capture the details of the completed project. It must be completed by the Retrofit Coordinator or by the relevant operatives, where the project consists only of DHC and/or DLMs

• Section C

• This section is designed to capture the details of the measures carried out. This must be completed by the Retrofit Coordinator. once the project/measure is completed

• Section D

• This section is designed to capture the details of district heating connection (DHC) measures that have been carried out as part of a project. It must be completed by the installer once the project/ measure is completed.

• Section E

• This section contains declarations of compliance with PAS, MCS and building/other regulations. It must be completed by all operatives carrying out measures within the project.

• Section F

• This section is developed to be signed from the Retrofit Coordinator or relevant operatives upon the completion of the ECO4 project. The section is designed to capture multiple operatives.

• Section G

• This section is designed to capture the POPT calculation for partial project cores. To be completed by the qualified operative who completed the installation in accordance with PAS, or other relevant standard where PAS is not applicable. May be completed offsite when work has been subcontracted.

A. Occupier/Landlord Details and Declaration

• Occupier or Landlord confirms all information is true by signing section A

• • The installation date recorded next to the measure(s) described on the following page or on
  the attached spreadsheet is/are correct.
  • The retrofit coordinator has demonstrated and explained the use and maintenance of (or
  relating to) any measure and has provided operating instructions and system documentation
  for the installed measure(s) described on the following page. The Installer has also made me
  aware of the need to continue to maintain the fabric (walls, floors, and roof).
  • I confirm that the premises was occupied before the date of completed installation4.
  • For Internal Wall Insulation measures, where any rooms have been left uninsulated, I confirm
  that the installer has made me aware of the importance of continuous ventilation, and heating
  those rooms to at least 18˚C.
  

• Customer Details

  Select

• Name of landlord²/managing agent³

• ²Including social housing providers
  ³Landlord’s authorised property management agent.
  

• Customer full name

• Customer address and postcode

• Customer contact phone number

• Customer email address

• Customer signature

  Sign

• If you are signing on behalf of the customer, you must not be the installer, energy supplier or any other party in the supply chain responsible for this measure. By signing this, you do not sacrifice any rights to remedy.

  Select I am signing on behalf of thecustomer N/A

  • I am signing on behalf of thecustomer
  • N/A

• Name

• Add signature

  Sign

• Relationship to customer

• Are all measures lodged with Trustmark

  Yes

  No

  N/A

• Project Number

• Only tick N/A if measures are not covered by PAS 2035

• Type of measures

  Select

• BFR Cost - Building Fabric Repair

• Installation Standards

  Select

• Has any other measure been carried out outside ECO eligible measures

  Yes

  No

• List the measures installed

• If a measure is installed outside the ECO eligible measures, then a full project score cannot be awarded.

• Has smart meter advice been issued

  Yes

  No

• Have innovation measures been installed

  Yes

  No

• Confirm evidence held to demonstrate correct product/ system followed

  Select A valid guarantee certificate which states the product/ system installed Mid and post install photographic evidence Other, please specify:

  • A valid guarantee certificate which states the product/ system installed
  • Mid and post install photographic evidence
  • Other, please specify:

• Has hydraulic balance carried out?

  Yes

  No

  N/A

• What is the post fuel type?

Insulation Measures

• Insulation Measures - Select all that apply

  Select

• Select

  0.027

  0.033

  0.04

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Cavity

  Solid

• Thickness Installed (mm)

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Cavity

  Solid

• Thickness Installed (mm)

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Cavity

  Solid

• Thickness Installed (mm)

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Cavity

  Solid

• Thickness Installed (mm)

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  LI_lessequal100

  LI_greater100 Start

• Depth (mm)

• Finish Depth (mm)

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Pitched (B11)

  Flat (B5)

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Select Yes - Residual loft insulated by installer No - Residual loft not installed by installer

  • Yes - Residual loft insulated by installer
  • No - Residual loft not installed by installer

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Solid

  Suspended

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Floor

  Wall

  Roof

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Single to double

  Improve double

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

Heating Measures

• Heating Measures - Select all that apply

  Select

• Type

  Broken

  Repair

  Upgrade

• Pas Annex

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Pas Annex

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  Select Programmer and room thermostat TRV's Smart Thermostats Weather Compensation Load Compensation TTZC

  • Programmer and room thermostat
  • TRV's
  • Smart Thermostats
  • Weather Compensation
  • Load Compensation
  • TTZC

• Number of programmers

• Room Thermostats

• Number of TRV's

• Number of Smart Thermostats

  Yes

  No

  N/A

• Number of Weather Compensation

• Load Compensation Number

• TTZC (Number of Zones)

• Number of Radiators

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Broken

  Repair

  Upgrade

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Type

  New

  Repair

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

Solar PV Only

• KWp

• OI Factor

• Inclination

• Orientation

• POPT %

Other measures (Including data light and alternative methodology) - Repeat section as necessary

• Type of Measure

• Product Details

• Is it POPT≥ 67%?

  Yes

  No

• Measure Date Installed

  Date

• Date of Handover

  Date

• Installer information

• Installer Name

• Company Name - Langley Properties Heating & Insulation Ltd

• Installer Address - 134 Leeds Road, Shipley, BD18 1BX

• Installer qualification:

  Select NVQ Level 2 or 3 in gas, plumbing, or mechanical engineering TrustMark registered installer Appropriate skills and experience: Please state below:

  • NVQ Level 2 or 3 in gas, plumbing, or mechanical engineering
  • TrustMark registered installer
  • Appropriate skills and experience: Please state below:

• State other relevant qualification eg certification schemes, gas safe etc.

• Information on the district heating system

  Select

• Details, including efficiency:

• Was a wet central heating system installed alongside the DHC?

  Yes

  No

• Consumer protection

• Registration with Heat Trust Scheme or equivalent:

  Select N/A – connection to a DHS that uses a shared ground loop Registered with Heat Trust Other equivalent arrangements - enter details of registration:

  • N/A – connection to a DHS that uses a shared ground loop
  • Registered with Heat Trust
  • Other equivalent arrangements - enter details of registration:

• Information for in-fill DHC measures

• If the project is a house in-fill, has a relevant person confirmed in writing that, to the best of that person’s knowledge and belief, no changes were made to the premises after the pre-installation EPC was issued and before the measure was completed which would increase the energy performance rating of the premises to band A, B or C.<br>

  Yes

  No

  N/A

• DHC measure installer signature and date:

  Sign

For measures in compliance with PAS, complete the declaration below - Repeat as necessary

• The installation of the energy efficiency measures listed below at the address provided in section A and handed over on the date listed in section C has been undertaken on the basis of a retrofit design claimed to comply with PAS 2035, using a process complying with PAS 2030, including Annexes indicated in section C.
  

• Measure

• Retrofit Installer

• Certification Body

For measures in compliance with MCS, complete the declaration below - Repeat as neccessary

• The installation of the energy efficiency measures listed below at the address provided in section A and handed over on the date listed in section C has been undertaken using an installation process complying with [*delete as appropriate*] *MIS 3002:2020* (for Solar PV) or *MIS 3004:2015* (for Biomass) or *MIS 3005:2017* (for Heat Pumps) or *MIS 3007:2018* (for MicroCHP).

• Measure

• Retrofit Installer

For measures not installed to PAS or MCS, complete the declaration below - Repeat as necessary

• I confirm the installation process used to carry out the energy efficiency measure listed below at the address provided in section A and handed over on the date listed in section C complies with building regulation and any other regulation that relates to the installation of the measure.

• Measure

• Installer/Operative

Please confirm the following statements are true by signing below:

• • I confirm that the installation details recorded for the measure(s) described on the
  previous pages or on the attached spreadsheet are true and correct. Any fraudulent
  activity including falsifying statements, falsifying signatures and copying - pasting may be
  reported to the Police/Action Fraud or a similar organisation. This may affect the validity of
  any measure installed and the measure may be rejected.
  • For First Time Central Heating measures I confirm that there is no evidence that at any
  point prior to the installation of the boiler the premises had a central heating system,
  district heating system, or renewable system nor, immediately prior to the installation, did
  the premises have a working, efficient electric storage heater(s).
  • The handover included copies of all relevant warranties and manuals, and verbal
  instructions were given on how to use and maintain the measure.

• For loft insulation measures with ≤ 100mm pre-existing insulation only: I confirm that a loft declaration is secured in the loft, near the hatch.

  Media

• For premises unoccupied after 1 April 2022 only:
  To the best of my knowledge, the property was built before 1 April 2022.

• Retrofit Coordinator / Operative Declaration and PAS details

• Name of Retrofit Coordinator

• PAS Certificate No(s):

• Company

• Address Details

Operative Details - Repeat as required

• Name of operative:

  Sign

• Pas Certificate Number(s):

• Company:

• Address details:

• Retrofit Coordinator name/signature & date of project completed installation: (To be filled by Retrofit Coordinator)

  Sign
Subcontracted operative signature (only to be completed when work is subcontracted) - Repeat as necessary

• Sub contract work undertaken?

  Yes

  No

• Name of operative:

  Sign

• Pas Certificate Number(s):

• Company:

• Address details:

G. POPT Calculation for ECO4 Partial Project Scores

• Enter areas with a different roof type (or where a different roof insulation measure/depth is
  being installed) as extensions. For RIRI, the total residual loft area should be included in the
  RIR area recorded below. For further information on RIRI measure please see RIRI section in
  ECO4 Delivery Guidance.

Roof Sections - repeat as necessary

• Property section (main loft, extension etc)

• Roof type

  Flat

  Pitched

  RIR

• Roof area (m²)

• m2 and type of insulation to be installed

  ≤ 100mm

  > 100mm

  FRI

  RIRI

• m²

• m²

• m²

• m²

• Total Roof Area (m²)

• Total for - select all that apply

  ≤ 100mm

  > 100mm

  FRI

  RIRI

• ≤ 100mm POPT = Total ≤ 100mm / Total Roof Area (%)

• > 100mm POPT = Total >100mm / Total Roof Area (%)

• FRI POPT = Total FRI / Total Roof Area (%)

• RIR POPT = Total RIR / Total Roof Area (%)

• RIR POPT = FRI Total % x RIR Total % / Total Roof Area (%)

Under Floor insulation measures only - Repeat as necessary

• Property section (main property, extension etc)

• Floor construction e.g. suspended timber

• Area m²

• m² of area to be installed

• Underfloor Insulation POPT = m² of insulation to be installed / Total floor area (%)

IWI / EWI / CWI measures only

Enter each different type of wall area as an extension. Wall area must include all heat loss
wall areas (including areas already insulated and areas that cannot be insulated). - Repeat as necessary

• Property section (eg, main property, extension, front walls etc)

• Wall construction E.g. Cavity / cob / solid stone / solid brick / system / timber / park home

• Wall area m² (excl windows and doors)

• M2 of insulation to be installed

  CWI

  EWI/IWI

• m²

• m²

• Total Wall Area m² (excl windows and doors)

• Total m² CWI to be installed

• Total m² EWI/IWI (type 2) to be installed

• CWI POPT = Total CWI m² to be installed /Total wall area (%)

• EWI/IWI POPT = Total EWI/IWI (type 2) m² to be installed /Total wall area (%)

Solid Floor insulation measures only

• Property section (main property, extension etc)

• Floor construction e.g. solid concrete

• Area m²

• m² of area to be installed

• Solid floor Insulation POPT = m² of insulation to be installed / Total floor area (%)