Title Page
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Conducted on
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First Line of Address and Postcode
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Prepared by
TENANT/HOMEOWNER
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Clients Name
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Address
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County
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Clients Date of Birth
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Landline Number
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Mobile Number
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Email Address
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Is Client Main Contact?
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Main Contact Name
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Relationship
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Contact Number
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Preferred Contact
- Landline
- Mobile
- Letter
CLIENT/LANDLORD DETAILS
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Name
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Contact Number
PROPERTY DETAILS
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Property Type
- House
- Bungalow
- Flat
- Maisonette
- Park Home
- Commercial
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Sub Property Type
- Detached
- Semi Detached
- End Terrace
- Mid Terrace
- Enclosed End Terrace
- Enclosed Mid Terrace
- Commercial
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Front Elevation
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Rear Elevation
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Right Elevation
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Left Elevation
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Orientation
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Front Elevation
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Rear Elevation
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Left Elevation
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Front Elevation
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Rear Elevation
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Right Elevation
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Orientation
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Front Elevation
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Rear Elevation
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Left Elevation
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Front Elevation
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Rear Elevation
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Right Elevation
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Front Elevation
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Rear Elevation
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Number of Storeys
- 1
- 2
- 3
- 4
- 5
- 5+
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State number of storeys
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Number of extensions
- None
- 1
- 2
- 3
- 4
- 5
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Number of Conservatories
- None
- 1
- 2
- 3
- 4
- 5
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Tenure
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State tenure type
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Number Of Bedrooms
- 1
- 2
- 3
- 4
- 5
- 5+
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State number of bedrooms
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Main Heating Type
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Please State Heating Type
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Appliance Type
- Gas Boiler
- LPG Boiler
- Gas Room Heaters
- Gas Fire with Back Boiler
- Gas Back Boiler to Radiators
- Other
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Photo of Gas meter
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Position of Flue
- External
- Internal
- Front Elevation
- Rear Elevation
- Side Elevation
- Other
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Please state Location
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Appliance Type
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Position of Flue
- External
- Internal
- Front Elevation
- Rear Elevation
- Side Elevation
- Other
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Appliance Type
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Position of Flue
- External
- Internal
- Front Elevation
- Rear Elevation
- Side Elevation
- Other
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Appliance Type
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Building Finish
- White
- Magnolia
- Pebble Dash
- Other
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Mortar Colour
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Mortar Colour
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Render Finish
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Render Finish
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Structural Condition
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Photos
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External Wall Condition
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Photos
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Building Defects
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List Building Defects
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Photos of Defects
ACCESS
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On site Parking
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Client Instructions
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Neighbour Access Required
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Is Neighbour Aware
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Access Issues
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Please list Access Issues
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Photos Of Access Issues
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Access Equipment Required
- Ladders
- Scaffolding
- Conservatory Ladder
- Extraction Lance
- Installation Lance
- Other
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Please State Additional Equipment
INSPECTION SURVEY
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Survey Type
- Cavity
- Loft
- Party Wall
- Extraction
- Floor Insulation
- Damp
- Other
EXTRACTION
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Reason for Extraction
- Low Density fill resulting in voids creating cold spots
- Building debris evidenced
- Building defects resulting in contaminated insulation
- Water penetration
- Other
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Additional Reason
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Boroscope Evidence
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Total Area to be Extracted
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Has Client been advised on extent of Drilling and extraction points?
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Are all potential ingress points been sealed internally?
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Recommended cavity drying Time
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If other please state
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Material being Extracted
- White Fibre
- Yellow Fibre
- Rockwool
- Bead
- Foam
- Building Debris
FOAM EXTRACTION
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Cavity Vents, Underfloor Vents, Bedroom Vents & Combustion Vents
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Have all vents been Identified?
- Yes
- No
- N/A
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Reason vents have not been identified
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Have all Internal vents been Identified?
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Please select rooms where vents to be sealed internally
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
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Photo
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Photo
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Photo
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Photo
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Photo
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Additional Room
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Photo
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Reason vents have not been identified
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Has Main Heating appliance been Identified?
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Has main heating have a Flue?
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Is flue directed through an External wall?
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Photo of Appliance
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Photo of Flue
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Position of Flue
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Photo of Flue
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Reason for Main Heating not being Identified
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Have all windows throughout the property been checked for possible areas of ingress?
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Please select rooms for possible areas of Ingress around Windows
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
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Photo
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Photo
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Photo
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Photo
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Photo
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Additional Rooms
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Photo
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Reason for checks not carried out?
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Have all Internal leaf walls been checked for hairline cracks and defects?
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Please select rooms where defects have been detected
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
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Living Room Photo
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Dining Room Photo
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Kitchen Photo
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Bathroom Photo
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Bedroom Photo
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Additional Rooms
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Additional Photo
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Reason checks have not been completed
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Have all areas behind appliances on external walls been checks for possible areas of Ingress?
- Yes
- No
- N/A
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Photos behind appliances
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Reasons for checks not completed
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Are there any Built-In wardrobes on external walls?
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Photo of Built-In wardrobes
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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?
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Has the client been made aware of the potential issues that may arise from extracting foam Insulation including the potential risk of dust ingress?
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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.
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Additional
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Assessors Signature
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Clients Signature
CAVITY WALL
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Scheme
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State type of scheme
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Total sqm to be Insulated
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Required Material
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If other please state
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Average Cavity Width
- 40mm
- 45mm
- 50mm
- 55mm
- 60mm
- 65mm
- 70mm
- 75mm
- 80mm
- 85mm
- 90mm
- 95mm
- 100mm
- 100mm+
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Please state correct average Cavity width
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Please select elevations to be installed
- Front
- Rear
- Left
- Right
- Extension
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Front Boroscope Photo
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Front DPC Photo
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Rear Boroscope Photo
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Rear DPC Photo
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Left Boroscope Photo
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Left DPC Photo
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Right Boroscope Photo
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Right DPC Photo
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Extension Boroscope Photo
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Extension DPC Photo
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Floor Type
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State floor Type
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Combustion vent Required?
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Photo of Appliance requiring Combustion vent
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Cavity Brush Required?
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Number of Cavity Brushes Required
- 1
- 2
- 3
- 4
- 5
- 5+
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Adjoining properties insulated?
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Reason Brushes not required
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Location of Chimneys
- Internal
- External
- Front Elevation
- Rear Elevation
- Side Elevation
- None
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Location of Flue
- Internal
- External
- Front Elevation
- Rear Elevation
- Side Elevation
- None
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Additional Notes
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Additional Photos
OTHER WORKS
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Please State Type of Works
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Details of required works
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Additional Information
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Photos
LOFT INSULATION
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Scheme
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State type of scheme
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Total Area to be Insulated
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Photo of Loft Hatch
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Photo of Loft space
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Existing Insulation
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Ofgem Loft Doc Required
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Photo of Loft Doc Close up
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Photo of Loft Doc in Situ
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Photo of existing depth
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Photo of Loft
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Down-lights present?
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Select Rooms Down-Lights Present
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
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Additional room
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Total number of Down-Lights
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Any water tanks need insulating?
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Large Tank
- None
- 1
- 2
- 3
- 4
- 5
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Medium Tank
- None
- 1
- 2
- 3
- 4
- 5
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Small Tank
- None
- 1
- 2
- 3
- 4
- 5
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Photo of tanks
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Any Pipework require Lagging?
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Please state meters of pipework
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High Amp electrical cables present? (e:g; Power Shower, Cooker)
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Photo of appliance
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Photo of Power Switch
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Loft Hatch needing D/P
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Relay Required?
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Relay Sqm
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Areas to be omitted
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Total area to be omitted
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Loft Vents required
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Walkway required
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Mtrs Required
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Loft Clearance
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Additional Notes
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Additional Photos
DAMP INSPECTION
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Select Damp Issue
- Condensation
- Penetrating Damp
- Rising Damp
- Water Penetration
- Leaking Plumbing
- Other
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State Damp Issue
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Rooms Affected
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
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Photos of Internal Issues
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Select rooms with issues
- Living Room
- Dining Room
- Kitchen
- Bathroom
- Bedrooms
- Other
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Photos of Internal Issues
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Has the property adequate ventilation
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Is there an obvious cause?
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Details
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Evidence
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Is the property in a good state of repair?
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Listed all Defects
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Description of Issue
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Conclusion
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Actions
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Additional Information
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Additional Photos
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Have Both Parties agreed to the measure?
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Is the Party Wall suitable to receive insulation?
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Area to be installed m2?
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Photo of Front elevation
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Photo of DPC Front
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Photo of Rear elevation
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Photo of DPC Rear
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Is there anything obstructing direct access to the Party Wall area?
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Any access issues that may require internal drill and fill of Party Wall?
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Photos of obstructions
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Has previously installed CWI migrated in to the Party Wall Void?
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Approximately how far has the Insulation migrated down the party wall void?
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Approximately how high up the void has the insulation risen?
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Photos of material migration in to party wall void
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Are there any openings in the internal gable walls?
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Photos of openings
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Photos of both internal gable walls!
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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. -
Photo of Measurement
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Photo of Party Wall Condition
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What is the finish on the internal walls?
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Photo of Internal walls
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If finish is Dot & Dab, is there a Parge coat present to a minimum of 8mm?
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Photo of Parge coat ( Identifiable within loft)
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State wall finish
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Are there any internal chimneys/flues present within the PW?
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Photo of Flue/Chimney on internal Party Wall
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If so distance from front & rear injection point?
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Spillage test required?
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Additional Comments
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Additional Photos
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Floor Insulation Pre-Installation Building Inspection Form
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PROJECT DETAILS
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Specifiers Contact Details
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SWIP UFI Roll Thickness
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The building inspector shall investigate and determine, as far as practicable:
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Is there any pre-existing damage to the areas that will be accessed by the installation operatives?
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Details of pre-existing damage
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Photo evidence
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What is the extent of the area and elements to be insulated?
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Were relevant checks been undertaken to determine if asbestos containing materials are present?
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Is the condition of the floor structure and the sub-floor void suitable for the works to commence in relation to:
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Existence of appropriate floor void ventilation arrangements;
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Photo of floor void ventilation
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The under-floor area being free from rodents/pests;
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Photos of under-floor area
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Timbers being free from rot and/or infestation;
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Photos of under-floor timbers
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Metal structural floor structure members being free from visible signs of corrosion;
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Photos of under-floor metal structure
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Electrical wiring is free from visible defects, e.g. damaged cables, trailing cables, exposed conductors;
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Photos of electrical wiring
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No visible signs of water penetration or water accumulation in the under-floor area;
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Photos of under-floor area
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No visible signs of leakage from water system components, e.g. pipework;
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Photos of water system and pipework
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Will the proposed installation:
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Be non-compliant with any requirements stated by the designer/specifier;
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Compromise the functionality of existing air supply/extract ventilation ducts/systems;
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Result in the unsafe operation of a combustion appliance - (Floor, vents, etc.);
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The Building Inspector shall confirm that the site layout or conditions will not impair the execution of the works in relation to:
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Appropriate access to the property and to the floor to be insulated
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Access Photos
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The room being free from stored items, floor coverings etc.
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General
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Is there any potential for moisture build up as a result of the installation?
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Will the functionality and/or safety of installed services (gas, electricity, water, telecommunications etc.) be affected in any way as a result of the installation?
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Is there any potential risk in relation to the ongoing performance of installed services? (If YES liaison with measure specifiers and/or service providers will need to take place).
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This Building Inspection must be carried out in conjunction with the full Design Specification and the prepared Method Statement.
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From the findings of this building inspection, is the installation able to be carried out in line with the full Design Specification?
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From the findings of this building inspection, is the Method Statement suitable and complete?
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Is there any evidence that any form of protected species would be disturbed by the installation process?
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NOTE: Any changes needing to be made or problems encountered as a result of this building inspection are required to be discussed with the specifier and/or customer as appropriate and agreement reached on how to proceed before work commences.
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Customer Understanding of the Extent of the Works
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Does the customer understand the nature and extent of the work?
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Have they been made aware of any disruption that may be caused (for example rubbish disposal and the siting of skips)
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Does the customer have any particular requests or requirements?
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Customer requirements
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Are the arrangements for site access and the storage of installation materials adequate and appropriate?
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Is there any other information which would help ensure the smooth running of the installation process?
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Additional information
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This building inspection and its findings, including those relating to the suitability and completeness of the installation method statement, the EEM specification and any customer-related issues, shall be made by the building inspector and retained by the installer, with a copy being made available to the EEM specifier.
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Floor Plan
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Upload Floor Plan Shade areas of floor plan that underfloor insulation to be applied and indicate how these areas are accessed.
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Customer Sign Off
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By signing the below you agree to the following statements:
• We have explained and you are aware of the nature and extent of the installation and this meets your expectations
• The Arrangements we have made for site access and installation materials storage are adequate and appropriate for the installation to be undertaken.
PAS2035
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Undertake Pas 2035
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Type of Works
- Cavity Wall
- Loft
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PAS 2035 CAVITY WALL
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Will the CWI Installation Work Result in Non-compliance with Building Regulations? e.g. Workmanship, Materials
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Will the CWI Work Result in Unsafe Operation of a Combustion Appliance? e.g. Flue
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Will the CWI Insulation Work Result in Compromise to the Functionality of Existing Ventilation Ducts/ Systems?
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Will the CWI Insulation Work Result in Compromise to the Functionality and/or Safety of Existing Services?
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Will the CWI Insulation Work Result in Installation that is Non-Compliant Material Supplier Requirement?
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Have relevant checks been undertaken to determine if asbestos containing materials are present?
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Type & Condition of Building Structure Suitable for Works to Commence
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Property Drilled to Establish Clear Cavity Width
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All Areas not to be Insulated are Agreed with Customer?
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Any Areas to be Insulated via the Internal Leaf Agreed with Customer?
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Scaffold Supplied by Customer?
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What is the Extent of the Cavity to be Filled?
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Will the Site layout or conditions impair the execution of the works?
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Is there any potential for moisture build up as a result of the insulation?
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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?
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Is there any Potential Risk in Relation to the Ongoing Performance of Installed Services?
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From the Findings of this Survey, Is the Installation able to be Carried out in Line with the Full Design Specification?
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From the Findings of this Survey, is the Method Statement suitable and Complete?
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Is there any Evidence that any Form of Protected Species would be Disturbed by the Installation Process?
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Does the Customer understand the Nature and Extent of the Works?
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Have they been made Aware of any Disruption that may be Caused? (e.g. Rubbish Disposal and the Siting of Skips)
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Does the Customer have any Particular Requests or Requirements?
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Are the Arrangements for Site Access and the Storage of Installation Materials adequate and Appropriate?
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Is there any other Information which would help ensure the smooth running of the Installation process?
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PAS 2035 LOFT INSULATION
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Is there any Pre-existing Damage to the Areas that will be Accessed by the Installation Operatives?
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Is the Condition of the Roof Space suitable for the Works in relation to the existence of appropriate Roof Space Ventilation arrangements?
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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?
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Is the Condition of the Roof Space suitable for the Works to Commence in relation to the Condition of the Ceilings?
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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?
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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)
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No Visible signs of Water Penetration
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No Visible signs of Leakage from Water System components? (e.g. Pipework, Cisterns, Tanks etc.)
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Following Investigation, will the proposed Installation be Non-compliant with any requirements stated by the Designer/ Specifier?
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Following Investigation, will the proposed Installation compromise the Functionality of Existing air supply/ Extract ventilation ducts/systems?
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Following Investigation, will the proposed Installation result in Unsafe operation of a Combustion Appliance?
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Following Investigation, will the proposed Installation Work Result in Non-compliance with Building Regulations? e.g. Workmanship, Materials, Fire Safety, Resistance to Moisture?
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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?
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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.?
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What is the Extent of the Area and Elements to be Insulated?
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Is there any potential for moisture build up as a result of the insulation?
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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?
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Is there any Potential Risk in Relation to the Ongoing Performance of Installed Services?
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From the Findings of this Survey, Is the Installation able to be Carried out in Line with the Full Design Specification?
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From the Findings of this Survey, is the Method Statement suitable and Complete?
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Is there any Evidence that any Form of Protected Species would be Disturbed by the Installation Process?
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Is the Condition of the Roof Space suitable for the Works to commence in relation the under floor area being free from Rodents/ Pests?
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Does the Customer understand the Nature and Extent of the Works?
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Have they been made Aware of any Disruption that may be Caused? (e.g. Rubbish Disposal and the Siting of Skips)
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Does the Customer have any Particular Requests or Requirements?
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Are the Arrangements for Site Access and the Storage of Installation Materials adequate and Appropriate?
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Is there any other Information which would help ensure the smooth running of the Installation process?
RISK ASSESSMENT
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Undertake Risk Assessment
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Type of Works
- Cavity Wall
- Loft
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Cavity Wall Insulation Risk Assessment Questions
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Overhead Electricity Cables Present?
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Does the Property have a Garage?
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Does the Property have a Porch?
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Does the Property have an Outside Tap?
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Does the Property have Finlock Gutters?
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Does the Property suggest that Asbestos could be Present?
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Confirm you have asked the Client if there was any known Asbestos or Asbestos containing materials within the property
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Do you or the Client have any Reason to suspect Asbestos is present in the Property?
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Access from Road/ Around Property
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Is there any Evidence of Vermin?
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Is there any Evidence of Protected Wildlife? (e.g. Bats)
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Use of a Mobile Tower Required?
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Working on Roof Required?
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Vibration Likely?
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High Noise Levels Likely?
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Working with Wet Cement/ Concrete/ Mortar required?
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Use of Mobile Elevation Working Platform (MEWP) required?
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If Obstructions present, can an extended Lance be used to Remedy?
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Reversing of Vehicle Required?
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Electricity Required?
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Housekeeping Required
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Distance from Works vehicle to Property
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Will Public Walkway be at Risk?
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Is neighbour access required?
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Safety Signage required?
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Loft Insulation Risk Assessment Questions
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Does the Property suggest that Asbestos could be Present?
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Confirm you have asked the Client if there was any known Asbestos or Asbestos containing materials within the property
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Do you or the Client have any Reason to suspect Asbestos is present in the Property?
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Have all checks been Undertaken to determine if Asbestos containing materials are present within the property?
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Access from Road/ Around Property
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Is there any Evidence of Vermin?
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Is there any Evidence of Protected Wildlife? (e.g. Bats)
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Vulnerable Person Present?
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Use of Ladders Required?
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Manual Handling Required?
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Reversing of Vehicle Required?
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Electricity Required?
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Housekeeping Required
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Distance from Works vehicle to Property
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Will Public Walkway be at Risk?
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Is neighbour access required?
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Safety Signage required?
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Electricity Cables present in Loft
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Working in Confined Spaces required?
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Lone Working?
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Use of Scaffold required?
DYNAMIC RISK ASSESSMENT
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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
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Assessors Name and Signature
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Customer's name and Signature
ECO COMPLIANCE DOC'S
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Upload Compliance Doc's
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POPT
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POPT (Paper Survey up to 6 pages)
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Benefit Details/Letters
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Benefit Details/Letters (up to 15 Pages)
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DSSY with a Floor Plan
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DSSY with a Floor Plan (12 Pages)
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Party Wall Consent form
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Signed by Owner of the subject Property and Neighbouring property/properties. (min 2 pages)
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EST Form
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EST Form (Signed by Owner Occupier 1 page)
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Land Registry Form
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Land Registry Form signed by Owner Occupier (1 page)
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LMCP
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Landlord Management Company Permission Form (only for privately rented 2 pages)
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Recent EPC
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EPC (only for privately rented 3 pages)
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Additional Supporting Evidence
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Additional Supporting Evidence (Title Deeds, Mortgage Statement, Tenancy Agreements (up to 20 pages)
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Additional Information and Photos
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Additional Information
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Additional Photos
QUOTATION
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Select Measures for Quotation
- Cavity
- Loft
- Party Wall
- Extraction
- Floor Insulation
- Damp
- Other
EXTRACTION
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Total m2
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Price
CAVITY WALL INSULATION
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Total m2
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Price
LOFT INSULATION
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Total m2
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Price
DAMP
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Total m2
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Price
OTHER WORKS
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Type of Works
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Price
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Quotation Form Photo
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Access Equipment Required
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Access Equipment Required
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Price
