Evolve Home Energy Solutions

• Audit Title

• Conducted on

  Date

• Prepared by

Tenant/Homeowner Details

• Name

• Address
  Address

• Phone Number

• Mobile Number

• Email Address

• Preferred Time of Contact

  Select Morning Afternoon Evening Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Morning
  • Afternoon
  • Evening
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

• Preferred Contact Method

  Select Landline Mobile Email Letter

  • Landline
  • Mobile
  • Email
  • Letter

Client/Landlord Details

• Name

• Address
  Address

• Phone Number

• Mobile Number

• Email Address

• Preferred Method of Contact

  Select Email Phone Call Letter Other

  • Email
  • Phone Call
  • Letter
  • Other

• Preferred Time of Contact

  Select Morning Afternoon Evening Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Morning
  • Afternoon
  • Evening
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

Property Details

• Property Type

  Select Mid-Terrace End terrace Semi-detached Detached Lower Flat Middle Flat Top Flat Masonette Other

  • Mid-Terrace
  • End terrace
  • Semi-detached
  • Detached
  • Lower Flat
  • Middle Flat
  • Top Flat
  • Masonette
  • Other

• Building finish

• Number of Bedrooms

• Type of Heating

  Select Gas Oil Solid Fuel Electric Other

  • Gas
  • Oil
  • Solid Fuel
  • Electric
  • Other

• Structural condition

  Safe

  At Risk

  N/A

• External Wall Condition

  Sound

  Un-sound

• Adequate ventilation to work area

  Yes

  No

  N/A

• Dampness or water damage

  Yes

  No

• Photo of each elevation

  Media

• Building defects

  Yes

  No

• Special Instructions

Access

• On site parking

• Client Instructions

• Access Issues

  Yes

  No

• Access Equipment Required

  Select None Ladders Tower Scaffolding Cherry Picker Scissor lift Spider Conservatory Ladder

  • None
  • Ladders
  • Tower
  • Scaffolding
  • Cherry Picker
  • Scissor lift
  • Spider
  • Conservatory Ladder

• Total area to be extracted

• Reason for extraction

• Has client been advised on extent on drilling and core holes

  Yes

  No

  N/A

• All vents cavity, underfloor, pantry, bedroom and combustion vents identified?

  Yes

  No

  N/A

• Photos of all vents to be sealed internally

  Media

• Is the main heating appliance flue'd through an external wall?

  Yes

  No

  N/A

• Photos of main heating appliance and flue

  Media

• Are all windows throughout the property adequately sealed to prevent ingress of dust ?

  Living Room

  Dining Room

  Kitchen

  Bathroom

  Bedrooms

• Photos of all window reveals sealed throughout the property

  Media

• Are there any hairline cracks on the internal leaf of all external walls where dust may ingress?

  Living Room

  Dining Room

  Kitchen

  Bathroom

  Bedrooms

• Photos of all hairline cracks on internal leaf of external walls

  Media

• Are all areas behind household appliances on external walls checked for areas of ingress?

  Yes

  No

  N/A

• Photos of wall areas behind household appliances

  Media

• Are there any built in wardrobes on external walls?

  Yes

  No

  N/A

• Photo of built in wardrobes

  Media

• Has the client been informed of the requirement for the technicians to complete a thorough seal up of the property prior to extraction works commencing?

  Yes

  No

• Has the client been made aware of all issues that may arise from the extraction of foam insulation in relation to dust ingress?

  Yes

  No

Condensation or Damp Issue

• Add media

  Media

Other Property Issues

• Add media

  Media

Dynamic Risk Assessment

• I have assessed the overall condition of the property ensuring it's suitability for extraction. Whilst every possible precaution is taken to seal up prior to any extraction works being started, it is not possible to ensure that dust and debris will not ingress in to 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 work to be undertaken.<br>

  None

  See Below

• Assessors signature

  Sign

• Client Signature

  Sign