Gas Safe Bristol & Somerset Boiler Installation Survey

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Property Type

• Detached House

• Semi detached house

• End of terrace

• Ground floor flat

• 1st floor Flat

• 2nd floor flat

• 3rd floor flat

• Bungalow

• Mobile home

• Other - SPECIFY BELOW

Existing Heating System Type

• Combi / Sealed

• System boiler / Sealed

• Heat Only Boiler / Open Vented

• Heat Only Boiler / Sealed

• Other - SPECIFY BELOW

Existing Hot Water System Type

• Mains pressure / Combi

• Mains pressure / unvented cylinder

• Gravity / cylinder

• Is the existing hot water system fully pumped?

  Yes

  No

  N/A

• Are there any power showers which may be effected by the pressurisation of the hot water?<br>If YES specify below

  Yes

  No

Existing Boiler Details

• MAKE / MODEL / OUPUT information required below

• Picture of existing Boiler required

  Media

Existing Flue Details

• Balanced / Fan flue / Horizontal

• Balanced / Fan flue / Verticle

• Balanced / Natural Draught / Horizontal

• Balanced / Natural Draught / Vertical

• Open Flue / Vertical

• Open Flue / Horizontal

• Other - SPECIFY BELOW

• Picture of Flue terminal required

  Media

Existing Boiler Electrical Connections

• Permanent live supply ?

  Yes

  No

  N/A

• Switch live supply?

  Yes

  No

  N/A

• Pump over run supply?

  Yes

  No

  N/A

Existing Gas Supply To Boiler

• 15mm

• 22mm

• 28mm

Existing Controls

• Integral programmer and room stat

• External programmer and room stat

• Programmer only

• Programmable room stat

• Are the existing controls in a good and usable condition?

  Yes

  No

  N/A

• Picture of heating controls

  Media

• Does the system have TRV's

  Yes

  No

  N/A

• Do the existing controls platform comply with Part L budding regulations?

  Yes

  No

  N/A

New Boiler Details

• Specify proposed new Boiler Details below E.G TYPE / OUPUT

New Boiler Location

• Specify the new Boiler location taking into account minimum clearance and cupboards or other site restrictions in close proximity

  Select Existing location Kitchen (proposed new location) Airing cupboard (proposed new location) Roof space (proposed new location) Garage (proposed new location) Bedroom (proposed new location) Bathroom (proposed new location) Utility (proposed new location) Lounge (proposed new location) Dining room (proposed new location)

  • Existing location
  • Kitchen (proposed new location)
  • Airing cupboard (proposed new location)
  • Roof space (proposed new location)
  • Garage (proposed new location)
  • Bedroom (proposed new location)
  • Bathroom (proposed new location)
  • Utility (proposed new location)
  • Lounge (proposed new location)
  • Dining room (proposed new location)

• Will the Boiler be located in a cupboard?

  Yes

  No

• If YES Specify cupboard dimensions below (Height x Width x Depth)

New Boiler Electrical Requirements

• Does the proposed new Boiler require a permanent live supply?

  Yes

  No

• Does the proposed new Boiler require a permanent pump over run supply?

  Yes

  No

• Will a suitably qualified electrician required to carry out Electrical amendments to the system?<br>If YES give details on scope of work required below

  Yes

  No

New Boiler Flue Details

• Vertical termination

• Horizontal termination

• Number of extensions required?

  0

  1

  2

  3

  4

• Number of 90 degree elbows required?

  0

  1

  2

  3

  4

• Number of 45 degree bends required?

  0

  1

  2

  3

  4

• Number of Flue support brackets required?

  0

  1

  2

  3

  4

• Is a lead slate required?

  Yes

  No

  N/A

Proposed New Controls Package

• What new controls are required?

  RF Programmable room stat

  RF Room stat only

  Mains room stat only

  Integral programmer (mechanical) and RF stat

• How many TRV's are required?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Size of required TRV

  8mm

  10mm

  15mm

New gas supply requirements

• Is the existing gas supply acceptable? <br>If NO give details of upgrade below

  Yes

  No

• Is a new 28mm gas meter union required?

  Yes

  No

Condense pipe and termination point

• Is there an existing condense pipe?<br>If NO give details of proposed termination point

  Yes

  No

  N/A

• Is a soak away required?

  Yes

  No

• Is a condense pump required?

  Yes

  No

New Hot Water Cylinder

• Is a replacement hot water cylinder required?

  Yes

  No

• What type of hot water cylinder is required?

  Vented (gravity)

  Unvented (pressurised)

• Will the new hot water cylinder be installed to the existing location?<br>If NO give proposed location details below

  Yes

  No

• Picture of hot water cylinder being replaced

  Media

• New hot water cylinder size?

  Select 100L 120L 150L 170L 190L 200L 210L 250L 300L

  • 100L
  • 120L
  • 150L
  • 170L
  • 190L
  • 200L
  • 210L
  • 250L
  • 300L

• Is the cylinder direct or indirect?

  Direct

  Indirect

• How many immersions does the new cylinder require?

  1

  2

Replacement Radiators

• How many replacement radiators including towel rails are required?

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15

• Details of all replacement radiators required below (SIZE / TYPE / ROOM / POSITION IN ROOM)
  E.G 600 x 1000 K2 / Master Bed / Existing Location under window

• How many new TRV's are required?

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15

• How many Lock-shields with drain off point are required?

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15

• How many standard lock-shields are required?

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15

• What size TRV's and lock shields are required?

  8mm

  10mm

  15mm

Making Good

• Will there be any making good of the external wall?<br>If YES give details below

  Yes

  No

• Yes

  No

  N/A

• Picture of external brick/wall face required

  Media

Core Material List

• In this section you are required to add a 'core material list' including quantity of tube, condense pipe, pumps and valves

  Drawing

• How many metres of 15mm tube is required?

  Select 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 50 51 54 57 60

  • 3
  • 6
  • 9
  • 12
  • 15
  • 18
  • 21
  • 24
  • 27
  • 30
  • 33
  • 36
  • 39
  • 42
  • 45
  • 48
  • 50
  • 51
  • 54
  • 57
  • 60

• How many metres of 22mm tube is required?

  Select 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 50 51 54 57 60

  • 3
  • 6
  • 9
  • 12
  • 15
  • 18
  • 21
  • 24
  • 27
  • 30
  • 33
  • 36
  • 39
  • 42
  • 45
  • 48
  • 50
  • 51
  • 54
  • 57
  • 60

• How many metres of 28mm tube is required?

  Select 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 50 51 54 57 60

  • 3
  • 6
  • 9
  • 12
  • 15
  • 18
  • 21
  • 24
  • 27
  • 30
  • 33
  • 36
  • 39
  • 42
  • 45
  • 48
  • 50
  • 51
  • 54
  • 57
  • 60

• How many metres of overflow pipe is required?

  3

  6

  9

  12

  15

• How many metres of 32mm plastic pipe is required?

  3

  6

  9

  12

  15

• How many metres of 40mm plastic pipe is required?

  3

  6

  9

  12

  15

• How many metres of 15mm tube is required?

  Yes

  No

  N/A