Title Page

  • Document No.

  • Survey title

  • Client

  • Job number

  • Conducted on

  • Prepared by

  • Location

Property details

  • Property type:

  • Enter storey/level

  • Number of bedrooms

Existing boiler details

  • Boiler type

  • Is it a condensing boiler?

  • Location

  • Manufacturer

  • Model

  • Flue type

  • Fuel type

  • Boiler output (KW)

  • Photo of existing appliance

  • Photo of flue termination

New boiler details

  • Recommended new boiler details

  • Details

  • Photo of new boiler position

  • Enter details of new boiler including height off work tops etc

  • Flue type

  • Details of flue system route

  • Photo of new flue terminal position

  • Details of flue termination

  • Photo of condense pipe route

  • Enter details for condense pipe route

Existing system details

  • Does existing system comply with Part L?

  • Details

  • Type of system fitted

  • Size of hot water cylinder

  • Hot water cylinder to be replaced

  • Details of new cylinder

  • Photo of existing hot water cylnder

  • Recommended controls required

  • Details of controls required

  • Thermostatic radiator valves fitted to existing system

  • Number of valves required

  • Is the system sealed/pressurised?

  • Is system to be sealed and tank removed?

  • Details

Radiators

  • If combination boiler is being fitted and cylinder removed, is a radiator required in the airing cupboard?

  • Details of new radiator

  • Kitchen radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size and location for new kitchen radiator

  • Hall radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size and location for new hall radiator

  • W.C radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size, type and location of new W.C radiator

  • Lounge radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size and location of new lounge radiator

  • Dining room radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size and location of new dining room radiator

  • Bedroom 1 radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size and location of new bedroom 1 radiator

  • Bedroom 2 radiator size and type

  • New radiator to be same size, type and location of existing?

  • Details of new size, type and location of new bedroom 2 radiator

  • Bedroom 3 radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size, type and location of new bedroom 3 radiatorq

  • Bedroom 4 radiator size and type

  • New radiator to be same size, type and location as existing?Yes

  • Details of new size, type and location of new bedroom 4 radiator

  • Bathroom radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size, type and location of new bathroom radiator

  • Landing radiator size and type

  • New radiator to be same size, type and location as existing?

  • Details of new size, type and location of new landing radiator

  • Details of any additional radiators

Electrical

  • 17th Edition fuse board fitted

  • Cross bonding required

  • Existing hard wired CO fitted in room to contain new boiler

  • Is it in date?

  • New hard wired CO alarm required

  • Details/location

Gas pipework

  • Details of gas pipework alterations required: Route, size, length etc

  • Photo of gas meter/gas bottle installation

  • Notes

Scaffolding

  • Is scaffolding required?

  • Details: Number of lifts, platforms required etc

  • Photos indicating location for tower and work area

  • Notes

Description of works to be carried out

  • Trades required to complete works

  • Details of other trades required

  • Description of works to be carried out

  • Estimated time required to complete works

Any other information

  • Details

Surveyors signature

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.