EHES - ECO3 SURVEY V1 - SafetyCulture

Title Page

Conducted on
First Line of Address and Postcode
Prepared by

TENANT/HOMEOWNER

Clients Name
Address
County
Clients Date of Birth
Landline Number
Mobile Number
Email Address
Is Client Main Contact?
Main Contact Name
Relationship
Contact Number
Preferred Contact
- Landline
- Mobile
- Email
- Letter

CLIENT/LANDLORD DETAILS

Name
Contact Number

PROPERTY DETAILS

Property Type
- House
- Bungalow
- Flat
- Maisonette
- Park Home
- Commercial
Sub Property Type
Front Elevation
Rear Elevation
Right Elevation
Left Elevation
Orientation
Front Elevation
Rear Elevation
Left Elevation
Front Elevation
Rear Elevation
Right Elevation
Orientation
Front Elevation
Rear Elevation
Left Elevation
Front Elevation
Rear Elevation
Right Elevation
Front Elevation
Rear Elevation
Number of Storeys
- 1
- 2
- 3
- 4
- 5
- 5+
State number of storeys
Number of extensions
- None
- 1
- 2
- 3
- 4
- 5
Number of Conservatories
- None
- 1
- 2
- 3
- 4
- 5
Tenure
State tenure type
Number Of Bedrooms
- 1
- 2
- 3
- 4
- 5
- 5+
State number of bedrooms
Main Heating Type
Please State Heating Type
Appliance Type
- Gas Boiler
- Electric Storage Heaters
- Oil Boiler
- LPG Boiler
- Solid Fuel Boiler
- Electric Boiler
- Gas room Heaters
- Solid Fuel Room Heaters
- Electric Room Heaters
- Gas Fire with Back Boiler
- Gas Back Boiler to Radiators
Position of Flue
- External
- Internal
- Front Elevation
- Rear Elevation
- Side Elevation
- Other
Please state Location
Photo of Gas meter
Position of Flue
- External
- Internal
- Front Elevation
- Rear Elevation
- Side Elevation
- Other
Position of Flue
- External
- Internal
- Front Elevation
- Rear Elevation
- Side Elevation
- Other
Building Finish
- White
- Magnolia
- Pebble Dash
- Other
Mortar Colour
Mortar Colour
Render Finish
Render Finish
Structural Condition
Photos
External Wall Condition
Photos
Building Defects
List Building Defects
Photos of Defects

ACCESS

On site Parking
Client Instructions
Neighbour Access Required
Is Neighbour Aware
Access Issues
Please list Access Issues
Photos Of Access Issues
Access Equipment Required
- Ladders
- Scaffolding
- Conservatory Ladder
- Extraction Lance
- Installation Lance
- Other
Please State Additional Equipment

INSPECTION SURVEY

Survey Type
- Cavity
- Loft
- Party Wall
- Extraction
- Damp
- Other

EXTRACTION

Reason for Extraction
- Low Density fill resulting in voids creating cold spots
- Building debris evidenced
- Building defects resulting in contaminated insulation
- Water penetration
- Other
Additional Reason
Boroscope Evidence
Total Area to be Extracted
Has Client been advised on extent of Drilling and extraction points?
Are all potential ingress points been sealed internally?
Recommended cavity drying Time
If other please state
Material being Extracted
- White Fibre
- Yellow Fibre
- Rockwool
- Bead
- Foam
- Building Debris

FOAM EXTRACTION

Cavity Vents, Underfloor Vents, Bedroom Vents & Combustion Vents
Have all vents been Identified?
- Yes
- No
- N/A
Reason vents have not been identified
Have all Internal vents been Identified?
Please select rooms where vents to be sealed internally
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
Photo
Photo
Photo
Photo
Photo
Additional Room
Photo
Reason vents have not been identified
Has Main Heating appliance been Identified?
Has main heating have a Flue?
Is flue directed through an External wall?
Photo of Appliance
Photo of Flue
Position of Flue
Photo of Flue
Reason for Main Heating not being Identified
Have all windows throughout the property been checked for possible areas of ingress?
Please select rooms for possible areas of Ingress around Windows
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
Photo
Photo
Photo
Photo
Photo
Additional Rooms
Photo
Reason for checks not carried out?
Have all Internal leaf walls been checked for hairline cracks and defects?
Please select rooms where defects have been detected
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
Living Room Photo
Dining Room Photo
Kitchen Photo
Bathroom Photo
Bedroom Photo
Additional Rooms
Additional Photo
Reason checks have not been completed
Have all areas behind appliances on external walls been checks for possible areas of Ingress?
- Yes
- No
- N/A
Photos behind appliances
Reasons for checks not completed
Are there any Built-In wardrobes on external walls?
Photo of Built-In wardrobes
Has the client been made aware of the requirement for technicians to complete internal checks and to seal up the property before extraction works can commence?
Has the client been made aware of the potential issues that may arise from extracting foam Insulation including the potential risk of dust ingress?
I have assessed the overall condition of the property ensuring its suitability for extraction. Whilst every possible precaution is taken to seal up prior to any extraction works commencing, it is not possible to ensure that dust and debris will not ingress into your property where previous trades have completed works on your property. Unless listed below, there are no additional significant hazards observed that are not addressed in the generic risk assessment for the works to be undertaken.
Additional
Assessors Signature
Clients Signature

CAVITY WALL

Scheme
State type of scheme
Total sqm to be Insulated
% of Property to be Installed
Required Material
If other please state
Average Cavity Width
- 40mm
- 45mm
- 50mm
- 55mm
- 60mm
- 65mm
- 70mm
- 75mm
- 80mm
- 85mm
- 90mm
- 95mm
- 100mm
- 100mm+
Please state correct average Cavity width
Please select elevations to be installed
- Front
- Rear
- Left
- Right
- Extension
Front Boroscope Photo
Front DPC Photo
Rear Boroscope Photo
Rear DPC Photo
Left Boroscope Photo
Left DPC Photo
Right Boroscope Photo
Right DPC Photo
Extension Boroscope Photo
Extension DPC Photo
Floor Type
State floor Type
Combustion vent Required?
Photo of Appliance requiring Combustion vent
Cavity Brush Required?
Number of Cavity Brushes Required
- 1
- 2
- 3
- 4
- 5
- 5+
Adjoining properties insulated?
Reason Brushes not required
Location of Chimneys
- Internal
- External
- Front Elevation
- Rear Elevation
- Side Elevation
- None
Location of Flue
- Internal
- External
- Front Elevation
- Rear Elevation
- Side Elevation
- None
Additional Notes
Additional Photos

OTHER WORKS

Please State Type of Works
Details of required works
Additional Information
Photos

LOFT INSULATION

Scheme
State type of scheme
Total Area to be Insulated
Photo of Loft Hatch
Photo of Loft space
Existing Insulation
Existing Depth
Ofgem Loft Doc Required
Photo of Loft Doc Close up
Photo of Loft Doc in Situ
Photo of existing depth
Depth to be Added
Photo of Loft
Depth to be Installed
Down-lights present?
Select Rooms Down-Lights Present
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
Additional room
Total number of Down-Lights
Any water tanks need insulating?
Large Tank
- None
- 1
- 2
- 3
- 4
- 5
Medium Tank
- None
- 1
- 2
- 3
- 4
- 5
Small Tank
- None
- 1
- 2
- 3
- 4
- 5
Photo of tanks
Any Pipework require Lagging?
Please state meters of pipework
High Amp electrical cables present? (e:g; Power Shower, Cooker)
Photo of appliance
Photo of Power Switch
Loft Hatch needing D/P
Relay Required?
Relay Sqm
Areas to be omitted
Total area to be omitted
Loft Vents required
Walkway required
Mtrs Required
Loft Clearance
Additional Notes
Additional Photos

DAMP INSPECTION

Select Damp Issue
- Condensation
- Penetrating Damp
- Rising Damp
- Water Penetration
- Leaking Plumbing
- Other
State Damp Issue
Rooms Affected
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
Photos of Internal Issues
Select rooms with issues
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
Photos of Internal Issues
Has the property adequate ventilation
Is there an obvious cause?
Details
Evidence
Is the property in a good state of repair?
Listed all Defects
Description of Issue
Conclusion
Actions
Additional Information
Additional Photos
Have Both Parties agreed to the measure?
Is the Party Wall suitable to receive insulation?
Area to be installed m2?
Photo of Front elevation
Photo of DPC Front
Photo of Rear elevation
Photo of DPC Rear
Is there anything obstructing direct access to the Party Wall area?
Any access issues that may require internal drill and fill of Party Wall?
Photos of obstructions
Has previously installed CWI migrated in to the Party Wall Void?
Approximately how far has the Insulation migrated down the party wall void?
Approximately how high up the void has the insulation risen?
Photos of material migration in to party wall void
Are there any openings in the internal gable walls?
Photos of openings
Photos of both internal gable walls!
Step 1: Internally measure from internal party wall to window/door reveal on both properties (A + B)
Step 2: Externally measure from window/door wall edge to window/door wall edge on both properties measurement (C) minus A + B = measurement (D)
Step 3: Deduct Plaster (12mm) or Plaster & Batten (37mm) and finally Brick/Block (100mm) from measurement (D) = Cavity width (E)
Step 4: Chalk mark the cavity width on wall this will identify the centre of the cavity ready for cavity inspection.
Party Wall Width ? ( Minimum of 40mm)
Photo of Measurement
Photo of Party Wall Condition
What is the finish on the internal walls?
Photo of Internal walls
If finish is Dot & Dab, is there a Parge coat present to a minimum of 8mm?
Photo of Parge coat ( Identifiable within loft)
State wall finish
Are there any internal chimneys/flues present within the PW?
Photo of Flue/Chimney on internal Party Wall
If so distance from front & rear injection point?
Spillage test required?
Additional Comments
Additional Photos

PAS2035

Undertake Pas 2035
Type of Works
- Cavity Wall
- Loft
PAS 2035 CAVITY WALL
Will the CWI Installation Work Result in Non-compliance with Building Regulations? e.g. Workmanship, Materials
Will the CWI Work Result in Unsafe Operation of a Combustion Appliance? e.g. Flue
Will the CWI Insulation Work Result in Compromise to the Functionality of Existing Ventilation Ducts/ Systems?
Will the CWI Insulation Work Result in Compromise to the Functionality and/or Safety of Existing Services?
Will the CWI Insulation Work Result in Installation that is Non-Compliant Material Supplier Requirement?
Have relevant checks been undertaken to determine if asbestos containing materials are present?
Type & Condition of Building Structure Suitable for Works to Commence
Property Drilled to Establish Clear Cavity Width
All Areas not to be Insulated are Agreed with Customer?
Any Areas to be Insulated via the Internal Leaf Agreed with Customer?
Scaffold Supplied by Customer?
What is the Extent of the Cavity to be Filled?
Will the Site layout or conditions impair the execution of the works?
Is there any potential for moisture build up as a result of the insulation?
Will the Functionality and/or safety of insulation services (Gas, Electricity, Water, Telecommunications etc.) be Affected in any way as a result of the Installation?
Is there any Potential Risk in Relation to the Ongoing Performance of Installed Services?
From the Findings of this Survey, Is the Installation able to be Carried out in Line with the Full Design Specification?
From the Findings of this Survey, is the Method Statement suitable and Complete?
Is there any Evidence that any Form of Protected Species would be Disturbed by the Installation Process?
Does the Customer understand the Nature and Extent of the Works?
Have they been made Aware of any Disruption that may be Caused? (e.g. Rubbish Disposal and the Siting of Skips)
Does the Customer have any Particular Requests or Requirements?
Are the Arrangements for Site Access and the Storage of Installation Materials adequate and Appropriate?
Is there any other Information which would help ensure the smooth running of the Installation process?
PAS 2035 LOFT INSULATION
Is there any Pre-existing Damage to the Areas that will be Accessed by the Installation Operatives?
Is the Condition of the Roof Space suitable for the Works in relation to the existence of appropriate Roof Space Ventilation arrangements?
Is the Condition of the Roof Space suitable for the Works to Commence in relation to the Timbers being free from Rot and/or Infestation?
Is the Condition of the Roof Space suitable for the Works to Commence in relation to the Condition of the Ceilings?
Is the Condition of the Roof Space suitable for the Works to Commence in relation to Metal Structural roof members being Free from Visible signs of Corrosion?
Is the Condition of the Roof Space suitable for the Works to Commence in relation to Electrical wiring being free from Visible defects? (e.g. Damaged Cables, Trailing Cables, Exposed Conductors)
No Visible signs of Water Penetration
No Visible signs of Leakage from Water System components? (e.g. Pipework, Cisterns, Tanks etc.)
Following Investigation, will the proposed Installation be Non-compliant with any requirements stated by the Designer/ Specifier?
Following Investigation, will the proposed Installation compromise the Functionality of Existing air supply/ Extract ventilation ducts/systems?
Following Investigation, will the proposed Installation result in Unsafe operation of a Combustion Appliance?
Following Investigation, will the proposed Installation Work Result in Non-compliance with Building Regulations? e.g. Workmanship, Materials, Fire Safety, Resistance to Moisture?
Will the Site Layout or Conditions impair the Execution of the works in relation to appropriate access to the property and to the roof space?
Will the Site Layout or Conditions impair the Execution of the works in relation to the roof space being free from Stored items, Boarding etc.?
What is the Extent of the Area and Elements to be Insulated?
Is there any potential for moisture build up as a result of the insulation?
Will the Functionality and/or safety of insulation services (Gas, Electricity, Water, Telecommunications etc.) be Affected in any way as a result of the Installation?
Is there any Potential Risk in Relation to the Ongoing Performance of Installed Services?
From the Findings of this Survey, Is the Installation able to be Carried out in Line with the Full Design Specification?
From the Findings of this Survey, is the Method Statement suitable and Complete?
Is there any Evidence that any Form of Protected Species would be Disturbed by the Installation Process?
Is the Condition of the Roof Space suitable for the Works to commence in relation the under floor area being free from Rodents/ Pests?
Does the Customer understand the Nature and Extent of the Works?
Have they been made Aware of any Disruption that may be Caused? (e.g. Rubbish Disposal and the Siting of Skips)
Does the Customer have any Particular Requests or Requirements?
Are the Arrangements for Site Access and the Storage of Installation Materials adequate and Appropriate?
Is there any other Information which would help ensure the smooth running of the Installation process?

RISK ASSESSMENT

Undertake Risk Assessment
Type of Works
- Cavity Wall
- Loft
Cavity Wall Insulation Risk Assessment Questions
Overhead Electricity Cables Present?
Does the Property have a Garage?
Does the Property have a Porch?
Does the Property have an Outside Tap?
Does the Property have Finlock Gutters?
Does the Property suggest that Asbestos could be Present?
Confirm you have asked the Client if there was any known Asbestos or Asbestos containing materials within the property
Do you or the Client have any Reason to suspect Asbestos is present in the Property?
Access from Road/ Around Property
Is there any Evidence of Vermin?
Is there any Evidence of Protected Wildlife? (e.g. Bats)
Use of a Mobile Tower Required?
Working on Roof Required?
Vibration Likely?
High Noise Levels Likely?
Working with Wet Cement/ Concrete/ Mortar required?
Use of Mobile Elevation Working Platform (MEWP) required?
If Obstructions present, can an extended Lance be used to Remedy?
Reversing of Vehicle Required?
Electricity Required?
Housekeeping Required
Distance from Works vehicle to Property
Will Public Walkway be at Risk?
Is neighbour access required?
Safety Signage required?
Loft Insulation Risk Assessment Questions
Does the Property suggest that Asbestos could be Present?
Confirm you have asked the Client if there was any known Asbestos or Asbestos containing materials within the property
Do you or the Client have any Reason to suspect Asbestos is present in the Property?
Have all checks been Undertaken to determine if Asbestos containing materials are present within the property?
Access from Road/ Around Property
Is there any Evidence of Vermin?
Is there any Evidence of Protected Wildlife? (e.g. Bats)
Vulnerable Person Present?
Use of Ladders Required?
Manual Handling Required?
Reversing of Vehicle Required?
Electricity Required?
Housekeeping Required
Distance from Works vehicle to Property
Will Public Walkway be at Risk?
Is neighbour access required?
Safety Signage required?
Electricity Cables present in Loft
Working in Confined Spaces required?
Lone Working?
Use of Scaffold required?

DYNAMIC RISK ASSESSMENT

I has assessed the conditions on site ensuring there is adequate ventilation. Unless listed below, there are no additional significant hazards observed that are not addresses in the generic risk assessment for the works to be undertaken
Assessors Name and Signature
Customer's name and Signature

ECO COMPLIANCE DOC'S

Upload Compliance Doc's
POPT
POPT (Paper Survey up to 6 pages)
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Benefit Details/Letters
Benefit Details/Letters (up to 15 Pages)
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DSSY with a Floor Plan
DSSY with a Floor Plan (12 Pages)
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Party Wall Consent form
Signed by Owner of the subject Property and Neighbouring property/properties. (min 2 pages)
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EST Form
EST Form (Signed by Owner Occupier 1 page)
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Land Registry Form
Land Registry Form signed by Owner Occupier (1 page)
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LMCP
Landlord Management Company Permission Form (only for privately rented 2 pages)
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Recent EPC
EPC (only for privately rented 3 pages)
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Additional Supporting Evidence
Additional Supporting Evidence (Title Deeds, Mortgage Statement, Tenancy Agreements (up to 20 pages)
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Additional Information and Photos
Additional Information
Additional Photos

QUOTATION

Select Measures for Quotation
- Cavity
- Loft
- Party Wall
- Extraction
- Damp
- Other

EXTRACTION

Total m2
Price

CAVITY WALL INSULATION

Total m2
Price

LOFT INSULATION

Total m2
Price

DAMP

Total m2
Price

OTHER WORKS

Type of Works
Price
Access Equipment Required
Access Equipment Required
Price

EHES - ECO3 SURVEY V1

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CLIENT/LANDLORD DETAILS

ACCESS

EXTRACTION

FOAM EXTRACTION

CAVITY WALL

OTHER WORKS

LOFT INSULATION

DAMP INSPECTION

EXTRACTION

CAVITY WALL INSULATION

LOFT INSULATION

DAMP

OTHER WORKS

Related checklists

EHES - ECO3 SURVEY V1

Free EHES - ECO3 SURVEY V1 Checklist

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CLIENT/LANDLORD DETAILS

ACCESS

EXTRACTION

FOAM EXTRACTION

CAVITY WALL

OTHER WORKS

LOFT INSULATION

DAMP INSPECTION

EXTRACTION

CAVITY WALL INSULATION

LOFT INSULATION

DAMP

OTHER WORKS

Related checklists