Information
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Location.
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First line of the Address
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Client Name.
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Tenure.
- Housing Association
- Local authority
- Private Home Owner
- Privately Rented
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Contact Details.
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Property Type.
- Mid-Terrace
- End terrace
- Semi-detached
- Detached
- Ground Floor Flat
- Middle Floor Flat
- Top Floor Flat
- Maisonette
- Bungalow
- House
- Commercial Building
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Number of Bedrooms.
- 1
- 2
- 3
- 4
- 5+
- N/A Commercial
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Floor construction Type
- Solid
- Suspended
- Block and beam
- Suspended and solid
- Other
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Construction age of Building.
Property details
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Survey conducted by.
- Vinnie Stokes
- Sean Glossop
- Rob Mckenna
- Alister Paisley
- Nick Hyett
- Steve Britton
- Lee Glenister
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Confirmation that relevant checks have been undertaken to determine if the presence of any asbestos containing material is present?
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Please take a photo of the building finish on all elevations and select the finish types.
- Brick
- Brick/Render
- Painted Render
- Painted faces brick
- Recon Stone/Sand Stone
- Pebble Dash/Spar
- Tile hung cladding
- PVC cladding
- Timber cladding
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If painted render or painted faced brick please provide the best colour match:
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Structural Condition.
- Structurally the building looks in a very good condition
- Structurally the building looks in a good condition
- Structurally the building looks in a poor condition
- Structurally the building looks in a very poor condition
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External Condition of the building.
- Very good
- Good
- Poor
- Very poor
- Brick faced building in an high exposure area not suitable for CWI
- Blown and damaged render in high exposure area not suitable for CWI until render repaired or replaced
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Is the property suitable to receive the insulation type specified?(Construction Type, Exposer, Condition of Structure)
- Yes
- No
- N/A
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Remedial Works Required, If yes please give details of remedial work required plus photos.
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Are all guttering / downspouts in good repair with no evidence of leaks / spills? In addition, if guttering is a Finlock system has this been lined? (Please take photos of any issues)
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Main Heating type, plus take photos of the appliance and ratings plate or appliance ID.
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Please make a visual check around the heating appliance for possible material ingress points.
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Location of the flue.
- Internal
- External
- Front Elevation
- Rear Elevation
- Left Hand Elevation
- Right Hand Elevation
- Flue passes through the roof space
- None
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Please take a photo of the flue and combustion vent if fitted.
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Have you checked for any holes around the flue?
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Secondary Heating.
- Gas Fire with Flue
- Gas Fire with chimney
- Gas Fire Flush Fitted
- Open Fire with internal chimney
- Open Fire with external chimney
- Electric fire in old fireplace
- Electric heaters in some of the rooms
- Oil filled heaters in some of the rooms
- Wood Burner
- No other heating present
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If secondary heating is present please take a photo of appliance and KW rating plate if accessible.
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Location of the Chimney.
- Internal
- External
- Front Elevation
- Rear Elevation
- Left Hand Elevation
- Right Hand Elevation
- Flue passes through the roof space
- None
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Please take a photo of the position of the chimney.
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Safety monitors present.
- Smoke Alarm
- Fire Alarm
- Carbon Monoxide Alarm
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Have the alarms all been tested by surveyor.
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Protected species or rodents present in building.
Access
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Access Issues please make notes and take photos of any issues.
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On site parking.
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Client Instructions.
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Access Equipment Required.
- None
- Ladders
- Scaffold Board for Flat Roof
- Scaffolding
- Conservatory Ladder
- Roof Ladder
Post Extraction Audit
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Inspection to be undertaken i.e Post extraction or cavity wall insulation.
- Post Extraction
- Cavity wall
Post Extraction.
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Inspection type.
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Date of inspection:
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Date the Original extraction was undertaken:
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Material Removed/Extracted
- Yellow Fibre
- White Fibre
- Foam
- Rockwool
- Unbonded EPS Bead
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Have you Boroscoped all elevations
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Please take photos of your Boroscope inspection.
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What are the condition of the wall ties?(Please provide at least 5 Photos)
- Good condition
- Signs of corrosion
- Covered in mortar/debris
- Corroded through
- Wall tie inspection required
- Small amount of mortar on wall but is will not affect the CWI.
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Are all elevations free of insulation and rubble.
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If you have answered NO please provide a photos of the elevation and mark the area of concern.
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Front elevation
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Rear elevation
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LHS elevation
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RHS elevation
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Have cavity barrier brushes been fitted? Provide photos evidence if you have answered yes and if no please provide a reason.
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Have all extraction holes been made good.(Please take photos)
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Does the finish match the existing mortar.
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Have all essential vents been checked and functioning correctly. (Sealed/Sleeved/Left open)
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If the cavities have been cleaned of a previous CWI Installation, can you confirm the cavities are suitable for re-installation?
- Yes please see post extraction report above.
- No, debris needs removing and wall ties cleaning and still a small amount of existing insulation to be removed.
- No, remedial works required before cavities refilled
- No, old insulation still present.
- Having scoped the cavities I'm unable to detect any issues with the existing cavity wall insulation.
- Brick faced building in an high exposure area not suitable for cavity wall insulation.
Internal Inspection:
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Have you done an internal inspection of the building? Including access to the loft space.(Please take photos of the loft and any damp found in the property)
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If you have answered yes please select the best description of your findings.
- 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
- No internal issues that I can see.
- Damage to plaster due to moisture penetration through the external walls.
- Mould and Mildew visible on internal wall's due to rubble and debris in cavity.
- Moisture migration to the internal walls due to lack of cross ventilation and low density cavity wall insulation.
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Has the loft space been checked for material ingress?
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Have the extraction crew stapled a flue certificate in the loft?
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Has a smoke spillage test been carried out on all fuel burning appliances that pass through the cavity?
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Is there any sign of material ingress post extraction.
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Was there moisture transfer due to failed CWI? If yes please provide information on which rooms.
- Yes, rubble and debris removed from cavity.
- Yes, wet insulation removed due to the exposure to wind driven rain.
- Yes, external ground floor level bridging cavity and surface moisture is permeating through the cavity walls.
- Yes, moisture transfer due to poor building maintenance.
- No, internal moisture migration to an area of low density cavity wall insulation (Thermal bridging)
- No, internal moisture migration due to lack of mechanical ventilation in the kitchen & bathroom.
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Please select the room that have been effected by moisture transfer.
- Lounge
- Dinning room
- kitchen
- Hallway
- W/C
- Bathroom
- Bedrooms
- Landing
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Add signature
Cavity Wall Insulation
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If you are carrying out a cavity wall survey please select Cavity wall from the drop down.
- Cavity wall Insulation
- No further survey required due to the exposure zone of the property.
- No further work required due to property being faced brick.
Cavity Wall Insulation:
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Scheme Type:
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Required material.
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Total area to be insulated.
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Total area to be omitted.
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Photos of omitted areas.
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Please take a photo of the overall cavity width across a door or window reveal.
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Please select the type of ventilation present, including extraction ventilation and trickle vents.
- Bathroom ventilation or extraction fan
- Kitchen ventilation or extraction fan
- Underfloor vents
- Trickle vents
- Pantry vents
- Bedroom ventilation
- Combustion ventilation
- No ventilation present
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Please take a photo of all vents and extraction fans fitted within the property including at lease two photos of window trickle vents.
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Do any of the air vents require sleeving or sealing up before installing the cavities.
- Yes
- No
- N/A
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If yes please select the air vents that require sleeving or sealing up.
- Bathroom ventilation or extraction fan
- Kitchen ventilation or extraction fan
- Underfloor vents
- Trickle vents
- Pantry vents
- Bedroom ventilation
- Combustion ventilation
- No ventilation present
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Adjoining properties insulated ?
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Number of Cavity brushes required.
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Combustion core vent required.
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Number of combustion vents required.
If funding available please answer additional ventilation questions below.
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If funding available please select yes.
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Are there any visible signs of surface condensation or damp?
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Does the property meet the minimum acceptable ventilation requirements set out in PAS 2035?
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Does the cooker have a hood which ventilates to the outside?
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Is there an airing cupboard or drying room that is ventilated to the outside?
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Is there a tumble dryer which is vented to the outside of the property?
- Yes
- No
- N/A
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Do all wet rooms have as a minimum some from of passive or purge ventilation? (opening windows, air bricks or trickle vents)
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Do all wet rooms have closing doors?
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Is there a passive ventilation system?
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Is there a mechanical ventilation system? (Continuous mechanical extract ventilation, Continuous mechanical ventilation with heat recovery)
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Is there evidence of intermittent heating to parts of the property ?e.g TRV's being turned down too low to unused areas.
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Are there appropriate controls in place to regulate the heating in the property?(thermostat, programmer etc)
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Is the thermostat set to a minimum of 10 Celsius in all parts of the property that are heated?
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Is there evidence of cloths being dried in the property?
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Are there more bedrooms than occupants?
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Is there single glazing at the property?
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Has the importance of behaviour to moisture and condensation been explained to the occupants and left behind?
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Is there a condensation calculation required? If so what elements?
Front Elevation.
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Photo of the elevation
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Please mark the position of the Boroscope hole with an S on the elevation photo.
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Please take a photo of the DPC showing a tape measure on each elevation.
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Photos of tape measure in the cavity.
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Cavity Depth.
- 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
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Comments
Rear Elevation
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Photo of the elevation
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Photos of tape measure in the cavity.
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Please mark the position of the Boroscope hole with an S on the elevation photo.
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Please take a photo of the DPC showing a tape measure on each elevation.
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Cavity Depth
- 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
Right hand elevation
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Comments
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Photo of the elevation
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Please mark the position of the Boroscope hole with an S on the elevation photo.
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Please take a photo of the DPC showing a tape measure on each elevation.
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Photos of tape measure in the cavity.
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Cavity Depth
- 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
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Comments
Left hand elevation
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Photo of the elevation
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Please mark the position of the Boroscope hole with an S on the elevation photo.
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Please take a photo of the DPC showing a tape measure on each elevation.
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Photos of tape measure in the cavity.
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Cavity Depth
- 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
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Comments
Building extensions
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Photo of the elevation
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Please mark the position of the Boroscope hole with an S on the elevation photo.
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Please take a photo of the DPC showing a tape measure on each elevation.
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Photos of tape measure in the cavity on each elevation.
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Cavity Depth
- 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
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Comments
Dynamic Risk Assessment & Client Declaration
Dynamic Risk Assessment.
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If you haven't carried out a Cavity wall survey please select NO.
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Asbestos.
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Use of a step ladders or ladder.
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Manual Handling.
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Hand tools.
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Vibration.
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Overhead electricity cables.
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Noise.
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Electricity/Generator
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Compressed air.
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Working on a roof.
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House keeping.
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Installation of cavity wall.
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Working with wet cement, concrete and mortar.
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Reversing vehicle.
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Use of a mobile tower.
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Use of mobile elevation working platform (mewp).
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Lone worker.
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Confirmation that the customer has been notified that Bierce or the BBA (British Board of Agreement) may contact them to arrange a visit to confirm suitability of the property? (we must inspect 10% so we will need to have an agreement about sharing customer’s data as we need to make appointments)
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I have assessed the conditions on site ensuring there is adequate ventilation and no evidence of damp and no remedial works required. 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.
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Assessors signature
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Clients Signature
Installation checks (to be completed by technician at install)Cavity wall.
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If you haven't carried out a Cavity wall survey please select NO.
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Crew leader.
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Date:
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No.2
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Have you stapled the flue certificate in the loft space? If no loft access please leave the flue certificate with the occupants.
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Cavity width(mm)
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Crew leader signature.
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Gables installed:
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Jet size used:
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Total m2 insulated.
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Pipe 1 Glue Flow in ml:
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Pipe 1 Bead Flow in kg:
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Pipe 2 Glue Flow in ml:
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Pipe 2 Bead Flow in kg:
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Number of barrier brushes fitted ?
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Number of cove vents fitted ?
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Number of vents replaced ?
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We're pre installation checks carried out ?
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We're post installation checks carried out ?
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Customer signature.