ECO4 & Great British Insulation Scheme Pre-Installation Project/ Measure Survey - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• The purpose of this form is to collect project/retrofit-level information before the installation of measure(s) takes place. The form may be completed offsite when installation is complete and can be used for both ECO4 and Great British Insulation Schemes.

• The information and details recorded here must be true and accurate. If issues arise that raise doubts around the accuracy of the evidence and information provided, measures will be investigated and may be rejected. Any fraudulent activity, including misrepresenting details of the property, may also be reported to law enforcement agencies.

• Any evidence of electronically duplicated or forged signatures will be investigated. Any measures where suspected fraudulent activity is detected will be rejected.

• 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 requirements.

• All photographic evidence in relation to a measure must be appropriate and in line with UK GDPR and Data Protection Act 2018 requirements.

• For a better understanding of how the data in this form will be used under the Great British Insulation Scheme or ECO4, please visit our website.

• Please be aware that some sections are scheme specific - and have been labeled as so. If a section or question is not relevant to your scheme, please leave section blank.

Completing the Pre-Installation Project/retrofit survey form

• Section A. Collects details of the premises where the project is being carried out, such as address, floor area segment and starting SAP band, and the measures that will be included in the project.

• Section B. Collects information on wall insulation measures. Only required for projects which include wall insulation.

• Section C. Collects information on heating controls and electric storage heaters. This section must be completed for any project which includes the installation of a heating measure.

• Section D. Collects information on a sketch plan of the premises. Its mandatory for all projects and can be completed by retrofit designer/assessor or retrofit coordinator.

• Section E. Declaration for completion by the Retrofit Coordinator or if a project consists solely of a connection to a district heating system (DHC) or a DHC and data light measures (DLMs) only, the DHC installer.

Customer, Retrofit Coordinator and Premises Details

• For PAS and GB insulation scheme measures, fields 1-2 and 6-10 are optional. Field 3 is optional for social housing. For Non-PAS measures, all fields are required.

• 1: Date of pre project RdSAP/SAP survey

  Date

• 2: Retrofit Coordinator:

  Name:

  Company Name:

  Tel:

  Email:

• 3: Name of Occupier

• 4: Address of installation and postcode

• 5: Property type (House, Flat/Maisonette, Park home)

  House

  Flat/Maisonette

  Park Home

• Field 6: Tenure type

  Owner Occupier

  Private Tenant

  Social Housing

• 7: Floor area segment (m²)

  0-72m2

  73-97m2

  98-199m2

  200+m2

• 8: Starting SAP Band

  Select High B High C High D High E High F High G Low B Low C Low D Low E Low F Low G

  • High B
  • High C
  • High D
  • High E
  • High F
  • High G
  • Low B
  • Low C
  • Low D
  • Low E
  • Low F
  • Low G

• 9: Starting SAP rating:

  Yes

  No

  N/A

• 10: Pre assessment number:

  RdSAP

  SAP

• Where relevant, pre retrofit EPC reference

• 11: Is the property in a rural area?

• Yes (Enter area code)

• Output Area Code

• 12: Has the sketch plan/floor plan of the premises been provided alongside pictorial evidence? Yes (See section D)

  Yes

  No

  N/A

• 13: Has smart meter advice been issued?

  Yes

  No

  N/A

What measure/s will be carried out following the pre-installation RdSAP / SAP project survey? (Please tick below the relevant boxes)

• Insulation Measures

• Wall Measures

  Cavity Wall Insulation

  External Wall Insulation

  Internal Wall Insulation

  Hybrid Wall Insulation

• Floor Measures

  Underfloor Insulation

  Solid Floor Insulation

• Roof Measures

  Loft Insulation

  Pitched Roof Insulation

  Flat Roof Insulation

  Room in Roof Insulation

• Park Home Insulation

  Floor

  Wall

  Roof

• Heating Measures

• Boiler Measures (ECO4 only)

  Repair

  Broken Replacement

  Upgrade

• Electric Storage Heaters Measures (ECO4)

  Repair

  Broken Replacement

  Upgrade

• Heating Control Measures

  Select Programmer and Room Thermostat Smart Thermostat TRVs Time and Temperature Zone Control Weather/Load Compensate

  • Programmer and Room Thermostat
  • Smart Thermostat
  • TRVs
  • Time and Temperature Zone Control
  • Weather/Load Compensate

• Other Measures

  Select Solar PV District Heating Connection or Repair Standard Alternative Methodology (AM) Data Light Measure

  • Solar PV
  • District Heating Connection or Repair
  • Standard Alternative Methodology (AM)
  • Data Light Measure

• Other Insulation Measures

  Select Draught Proofing Window Glazing Single to Double Improved Double Higher Performance External Doors

  • Draught Proofing
  • Window Glazing
  • Single to Double
  • Improved Double
  • Higher Performance External Doors

Information on Wall Insulation Measures

• All wall insulation measures

• 1. Approximate construction year or age band, plus reasoning

• 2. Predominate wall construction type eg solid brick, timber frame or system build

• 3. Percentage of total wall area this wall type: %

• Cavity wall insulation measures

  Yes

  No

  N/A

• 4. Are you claiming on ECO for extracted failed cavity wall?

  Yes

  No

  N/A

• 5. Are the walls already partially insulated?

  Yes

  No

  N/A

Information for Heating Measures

• Is there a full set of functioning pre-existing heating controls?

  Yes

  No

  N/A

• What working heating controls currently exist?

  Room Thermostat

  Boiler Programmer

  Smart Thermostat

  TRV (if TRV please go to 2a)

• 2a) TRV

• The existing number of radiators:

• The existing number of radiators with TRVs:

• The existing number of heated towel rails:

• The existing number of heated towel rails with TRVs:

• Does the system incorporate a bypass radiator?

  Yes

  No

  N/A

• Pre-existing ESH (ECO4 only)

  Yes

  No

  N/A

• Type:

• Responsiveness:

Sketch Plan and instructions for all measure types

• Basic sketch plan instructions for all measure types

• Room Key: BR# = Bedrooms; LR = Living Room; K = Kitchen; D = Dining Room; BTH = Bathroom. Wall Type key: Cavity/non-cavity; Adjacent to unheated space/corridor. Doors should only be included where the measure being scored is a high-performance external door, and windows should only be included where the measure is window glazing.

• Sketch plan instruction by measure type

• Heating Measures

• HS# = heating system/boiler (HS1 = main heating source) RAD = Radiator with no existing TRV RADT = Radiator with existing TRV RS = Room stat ST = Smart Thermostat TW = Towel Rail TWTRV = Towel rails with TRVs RH = Room Heater ESH = Storage Heater UFH = Under Floor Heating

• Roof, wall, and floor measures

• The location of pre-main heat source(s) should be clearly recorded on the sketch using the key in the 'heating measures' column. PR = Pitched roof Fr = Flat roof RIR = Room in roof RES = RIRI Residual Loft Area UFI = Under Floor Insulation (specify solid or suspended)

Retrofit Coordinator or DHC Installer Declaration

• 1: Name, company, and address:

• Trustmark License Number or DHC Installer (TMLN) :

• 2: I confirm that all the information on this form has been accurately presented:

  Yes

  No

  N/A

• If no, enter what has not been declared and what's the reason for not declaring it

  Yes

  No

  N/A

• 3: I confirm that the building was pre-existing before 1 April 2022:

  Yes

  No

  N/A

• 4: Retrofit Coordinator or DHC Installer Signature and Date

  Sign