F223: Pre-extraction and Cavity Cleaning Survey: Low Carbon Exchange Ltd V1.3

• Location.
  Address

• First line of the Address.

• Type of survey

• Client Name.

  Select Alliance Homes Abri Curo Cornwall Exeter CC Homes in Sedgemoor Ian Williams Ltd North Devon Homes PCH Livewest Sovereign Westwood Housing WHS Ltd

  • Alliance Homes
  • Abri
  • Curo
  • Cornwall
  • Exeter CC
  • Homes in Sedgemoor
  • Ian Williams Ltd
  • North Devon Homes
  • PCH
  • Livewest
  • Sovereign
  • Westwood Housing
  • WHS Ltd

• Tenants or Home owners name.

• Contact Details.

• Tenure.

  Select Owner occupier Local Authority Housing Association Privately Rented

  • Owner occupier
  • Local Authority
  • Housing Association
  • Privately Rented

• Survey conducted by.

  Select Vinnie Stokes Sean Glossop Rob Mckenna Alister Paisley Nick Hyett Steve Britton Lee Glenister

  • Vinnie Stokes
  • Sean Glossop
  • Rob Mckenna
  • Alister Paisley
  • Nick Hyett
  • Steve Britton
  • Lee Glenister

• Type of Survey

  Failed Insulation

  Debris removal

  Wall tie inspection

• Property Type.

  Select Mid-Terrace End terrace Semi-detached Detached Ground Floor Flat Middle Floor Flat Top Floor Flat Masonette Bungalow House Commercial Building

  • Mid-Terrace
  • End terrace
  • Semi-detached
  • Detached
  • Ground Floor Flat
  • Middle Floor Flat
  • Top Floor Flat
  • Masonette
  • Bungalow
  • House
  • Commercial Building

• Construction age of the building.

• Floor Construction Type

  Select Solid Suspended Suspended not wood Block and beam Other

  • Solid
  • Suspended
  • Suspended not wood
  • Block and beam
  • Other

• Number of Bedrooms.

  Select 1 2 3 4 5+ N/A Commercial

  • 1
  • 2
  • 3
  • 4
  • 5+
  • N/A Commercial

• Heating Type?

  Select Mains Gas Oil Solid Fuel Electric Renewable Energy LPG Heating no working at the time of survey

  • Mains Gas
  • Oil
  • Solid Fuel
  • Electric
  • Renewable Energy
  • LPG
  • Heating no working at the time of survey

• Please take photo of main heating type.

  Media

• Secondary Heat source.

  Select Gas Fire with Flue Gas Fire with chimney Gas Fire Flush Fitted Open Fire with internal chimney Open Fire with external chimney Wood Burner No other heating present

  • Gas Fire with Flue
  • Gas Fire with chimney
  • Gas Fire Flush Fitted
  • Open Fire with internal chimney
  • Open Fire with external chimney
  • Wood Burner
  • No other heating present

• Building Finish.

  Select Brick Painted Render Brick/Render Pebble Dash Recon Stone Spar Limestone/Sandstone Granite/Whinstone Faced brick in a high exposure area not suitable for cavity wall insulation

  • Brick
  • Painted Render
  • Brick/Render
  • Pebble Dash
  • Recon Stone
  • Spar
  • Limestone/Sandstone
  • Granite/Whinstone
  • Faced brick in a high exposure area not suitable for cavity wall insulation

• Structural Condition.

  Select Very good Good Poor Very poor Faced brick showing damaged to brick faces and poor mortar joints Painted faced brick showing damaged to brick faces and poor mortar joints Faced brick in a high exposure area if being cavity filled we advise that the property is treated with Storm dry

  • Very good
  • Good
  • Poor
  • Very poor
  • Faced brick showing damaged to brick faces and poor mortar joints
  • Painted faced brick showing damaged to brick faces and poor mortar joints
  • Faced brick in a high exposure area if being cavity filled we advise that the property is treated with Storm dry

• External Condition of the building.

  Select Very good Good Poor Very poor Faced brick showing damaged to brick faces and poor mortar joints Painted faced brick showing damaged to brick faces and poor mortar joints Faced brick in a high exposure area if being cavity filled we advise that the property is treated with Storm dry

  • Very good
  • Good
  • Poor
  • Very poor
  • Faced brick showing damaged to brick faces and poor mortar joints
  • Painted faced brick showing damaged to brick faces and poor mortar joints
  • Faced brick in a high exposure area if being cavity filled we advise that the property is treated with Storm dry

• Remedial Works Required.

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If yes please give details of remedial work required plus photos.

• Have you done an internal inspection of the building.

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If you have answered yes please select the best description of your findings.

  Select Low level damp near the skirting boards Black mould in the corners of the rooms Black mould on the ceiling and the walls Condensation on the windows and external walls Area's of mould around the window reveals. Mould around the window lintels. Signs of moisture ingress through the external walls. Mould on the sloping ceilings. No internal issues that I can see. Damaged to internal plaster due to the property being faced brick and moisture ingress.

  • Low level damp near the skirting boards
  • Black mould in the corners of the rooms
  • Black mould on the ceiling and the walls
  • Condensation on the windows and external walls
  • Area's of mould around the window reveals.
  • Mould around the window lintels.
  • Signs of moisture ingress through the external walls.
  • Mould on the sloping ceilings.
  • No internal issues that I can see.
  • Damaged to internal plaster due to the property being faced brick and moisture ingress.

• Please take photos of your internal findings.

  Media

• Safety monitors present.

  Select Smoke Alarm Fire Alarm CO2 Alarm

  • Smoke Alarm
  • Fire Alarm
  • CO2 Alarm

• Have the alarms all been tested by surveyor.

  Yes

  No

  N/A

• Protected species or rodents present in building.

  Yes

  No

  N/A

• Special Instructions.

Access

• On site parking.

• Client Instructions.

• Access Issues.

  Yes

  No

  N/A

• Access Equipment Required.

  Select None Ladders Scaffold Board for Flat Roof Scaffolding Conservatory Ladder Roof Ladder

  • None
  • Ladders
  • Scaffold Board for Flat Roof
  • Scaffolding
  • Conservatory Ladder
  • Roof Ladder

Details

• Total area to be extracted, cleaned or inspected.

• Material to be extracted.

  Select Yellow/White Fibre Foam Rockwool Loose polystyrene bead Debris / Rubble Over bonded bead

  • Yellow/White Fibre
  • Foam
  • Rockwool
  • Loose polystyrene bead
  • Debris / Rubble
  • Over bonded bead

• Average Cavity Depth.

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
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  • 85mm
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  • 95mm
  • 100mm
  • 105mm
  • 110mm
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  • 130mm
  • 135mm
  • 140mm
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  • 150mm
  • 155mm
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  • 165mm
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  • 175mm
  • 180mm
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  • 200mm

• Total area to be omitted.

• Photos of omitted areas.

  Media

• Are there any mechanical ventilation fans fitted in the property?

  Yes

  No

  N/A

• If yes please select which room.

  Select Kitchen Bathroom Utility W/C En-suite Cooker hood Positive input ventilation Passive ventilation (Opening window)

  • Kitchen
  • Bathroom
  • Utility
  • W/C
  • En-suite
  • Cooker hood
  • Positive input ventilation
  • Passive ventilation (Opening window)

• Are the mechanical ventilation fans working? If so please select which rooms.(survey to run fan for a few minutes)

  Select Kitchen Bathroom Utility W/C En-suite Cooker hood Positive input ventilation Passive ventilation (Opening window)

  • Kitchen
  • Bathroom
  • Utility
  • W/C
  • En-suite
  • Cooker hood
  • Positive input ventilation
  • Passive ventilation (Opening window)

• Does the building have any air vents.

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If yes please select.

  Select Underfloor vents Kitchen vents Bedroom vents Bathroom vents Combustion vents Pantry vents Trickle vents No ventilation within the building

  • Underfloor vents
  • Kitchen vents
  • Bedroom vents
  • Bathroom vents
  • Combustion vents
  • Pantry vents
  • Trickle vents
  • No ventilation within the building

• Do any of the air vents require sleeving or sealing up before installing the cavities.

  Yes

  No

  N/A

• If yes please select the air vents that require sleeving or sealing up.

  Select Underfloor vents Kitchen vents Bedroom vents Bathroom vents Combustion vents Pantry vents Trickle vents No ventilation within the building

  • Underfloor vents
  • Kitchen vents
  • Bedroom vents
  • Bathroom vents
  • Combustion vents
  • Pantry vents
  • Trickle vents
  • No ventilation within the building

• Adjoining properties insulated ?

  Yes

  No

  N/A

• Number of Cavity brushes required.

• Core vent required.

  Yes

  No

  N/A

• Number of core vents and location.

• Location of chimneys.

  Select Internal External Front Elevation Rear Elevation Left Hand Elevation Right Hand Elevation None

  • Internal
  • External
  • Front Elevation
  • Rear Elevation
  • Left Hand Elevation
  • Right Hand Elevation
  • None

• Location of flue.

  Select Internal External Front Elevation Rear Elevation Left Hand Elevation Right Hand Elevation None

  • Internal
  • External
  • Front Elevation
  • Rear Elevation
  • Left Hand Elevation
  • Right Hand Elevation
  • None

Front Elevation.

• Cavity Depth.

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
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  • 95mm
  • 100mm
  • 105mm
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  • 130mm
  • 135mm
  • 140mm
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  • 150mm
  • 155mm
  • 160mm
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  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Add drawing

  Drawing

• Photo of elevation .

  Media

• Please mark the position of the Boroscope hole with an S on the elevation drawing.

  Yes

• Boroscope Photos.

  Media

• Comments

Rear Elevation

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
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  • 85mm
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  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
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  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Add drawing

  Drawing

• Photo of elevation

  Media

• Please mark the position of the Boroscope hole with an S on the elevation drawing.

  Yes

• Boroscope Photos.

  Media

• Comments

Right hand elevation

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Add drawing

  Drawing

• Photo of elevation

  Media

• Please mark the position of the Boroscope hole with an S on the elevation drawing.

  Yes

• Boroscope Photos.

  Media

• Comments

Left hand elevation

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
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  • 85mm
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  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
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  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Add drawing

  Drawing

• Photo of elevation

  Media

• Please mark the position of the Boroscope hole with an S on the elevation drawing.

  Yes

• Boroscope Photos.

  Media

• Comments

Building extensions

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Add drawing

  Drawing

• Photo of elevation

  Media

• Please mark the position of the Boroscope hole with an S on the elevation drawing.

  Yes

• Boroscope Photos.

  Media

• Comments

Summary of your finding and reasons for the extraction of the existing cavity wall insulation:

• undefined

• Add signature

  Sign

Dynamic Risk Assessment.

• Reversing vehicle.

  Yes

  No

  N/A

• Asbestos.

  Yes

  No

  N/A

• Overhead electricity cables.

  Yes

  No

  N/A

• Use of a step ladders or ladder.

  Yes

  No

  N/A

• Use of a mobile tower.

  Yes

  No

  N/A

• Manual Handling.

  Yes

  No

  N/A

• Working on a roof.

  Yes

  No

  N/A

• Hand tools.

  Yes

  No

  N/A

• Vibration.

  Yes

  No

  N/A

• Noise.

  Yes

  No

  N/A

• Electricity/Generator

  Yes

  No

  N/A

• Compressed air.

  Yes

  No

  N/A

• House keeping.

  Yes

  No

  N/A

• Working with wet cement, concrete and mortar.

  Yes

  No

  N/A

• Use of mobile elevation working platform (mewp).

  Yes

  No

  N/A

• Lone worker.

  Yes

  No

  N/A