Title Page
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Site Surveyed
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Store Number
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Prepared by
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Conducted on
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Asbestos Register Reviewed and Signed
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Photo of Store Front
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What is the current external temperature
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Photo of Signing In Book
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Name of person authorizing entry
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Has visible asset list been obtained from Gondola Help Desk
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Has the Job Call out list been obtained from Gondola Help Desk
Main Salesfloor
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Lighting Type - LED or None LED
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Lighting Types
- Recessed Panels
- Recessed Spots
- Recessed Linear
- Surface Linear
- Surface Spots
- Track Linear
- Track spots
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Does the Salesfloor have temp mapping
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how many probes are on the salesfloor?
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Salesfloor Temperature - Mark location 1 on drawing
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Salesfloor Temperature - Mark location 2 on drawing
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Salesfloor Temperature - Mark location 3 on drawing
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Salesfloor Temperature - Mark location 4 on drawing
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Salesfloor Temperature - Mark location 5 on drawing
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Salesfloor Temperature - Mark location 6 on drawing
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Salesfloor Lux Plots required - Mark location 1 on drawing
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Salesfloor Lux Plots required - Mark location 2 on drawing
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Salesfloor Lux Plots required - Mark location 3 on drawing
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Salesfloor Lux Plots required - Mark location 4 on drawing
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Salesfloor Lux Plots required - Mark location 5 on drawing
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Salesfloor Lux Plots required - Mark location 6 on drawing
External Doors and Entrances
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How many external doors or entrances does the store have?
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Door 1 Height and Width
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Door 1 Heater Type
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Door 1 Height and Width
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Door 1 Heater Type
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Door 2 Height and Width
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Door 2 Heater Type
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Door 1 Height and Width
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Door 1 Heater Type
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Door 2 Height and Width
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Door 2 Heater Type
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Door 3 Height and Width
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Door 3 Heater Type
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Door 1 Height and Width
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Door 1 Heater Type
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Door 2 Height and Width
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Door 2 Heater Type
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Door 3 Height and Width
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Door 3 Heater Type
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Door 4 Height and Width
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Door 4 Heater Type
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Are the door curtains running currently?
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Are they omitting hot air?
Deli/Counters
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Does the Store have a Deli/Counters
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What time does the deli begin operating?
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What time does the deli stop operating?
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What is the source of hot water?
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Is Drainage pumped or gravity?
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How many sinks service the area
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What type of lighting is installed?
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What is the total number of fittings and wattages?
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How is the lighting controlled?
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Is the area serviced by extract canopies?
Bakery<br>
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Does the Store have a Bakery
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What time does the Bakery begin operating?
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What time does the Bakery stop operating?
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What is the source of hot water?
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Is Drainage pumped or gravity?
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How many sinks service the area
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What type of lighting is installed?
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What is the total number of fittings and wattages?
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How is the lighting controlled?
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Is the area serviced by extract canopies?
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What is the type and consumption of the oven? (take photo of spec plate)
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Are there any other pieces of kit that are classed as big users of energy (Dishwashers, Rack Ovens etc)
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What items of kit are present?
- Dishwasher
- Rack Ovens
- Large Water Boilers
- Other1
- Other2
Customer Cafe
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Does the Store have a Customer Cafe
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What time does it begin serving?
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What time does it stop serving?
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Is the area serviced by AC cassettes?
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What is the source of hot water?
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Is Drainage pumped or gravity?
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What type of lighting is installed?
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What is the total number of fittings and wattages?
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How is the lighting controlled?
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Is the area serviced by extract canopies?
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Are there any other pieces of kit that are classed as big users of energy (Dishwashers, Ovens, Hot Taps etc)
- Dishwasher
- Ovens
- Hot Taps
- Other1
- Other2
BOH Rooms Offices and Conference
- BOH Room
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Room Name -
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Lighting Type
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number and wattage of fittings
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Heating Type
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Does the room have windows?
Colleagues Canteen
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Does the Store have a Colleagues Cafe
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Is the area serviced by AC cassettes?
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What is the source of hot water?
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Is Drainage pumped or gravity?
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What type of lighting is installed?
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What is the total number of fittings and wattages?
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How is the lighting controlled?
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Is the area serviced by extract canopies?
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Are there any other pieces of kit that are classed as big users of energy (Dishwashers, Ovens, Hot Taps etc)
- Dishwasher
- Ovens
- Hot Taps
- Other1
- Other2
Main Boiler Plant Room
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Where is the main boiler room located?
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Where is the key for the main boiler plant room?
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Does the store have a central heating system?
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What type and size is the boiler?
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Is there a service record for the boiler?
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What temperatures is the boiler set to run at?
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What brand and size is the pump?
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Is there tank storage?
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is there an extract system in the room?
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Is the extract system controlled?
Main Electrical Plant Room and Distribution
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Where is the main electrical incoming room located?
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Where is the key for the main electrical incomer room?
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Does the store have a generator?
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What size is the generator?
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Is the generator live and in standby mode?
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Is there a maintainance log?
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Does the store have a central battery system for emergency lights?
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Does the store have a PFC or VO?
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What size is the main incoming breaker? (Amps)
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What is the rating of the panel board? (Amps)
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Is there a schematic mounted on the wall?
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is there an extract system in the room?
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is the extract system controlled?
Warehouse and Service Yard
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Do the doors have ODACs above them?
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What is being used to condition the air?
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What type of lighting is installed?
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What is the quantity and wattage of the fittings?
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How is the lighting controlled?
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Are all door seals and flaps in good condition?
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Are all condensing units running and free from ice build up?
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Are all coldrooms utilising LED lighting?
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What is the quantity and wattages of fittings?
Roof Plant
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Is there a roof area for plant?
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Are AHUs on the roof plant area?
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Are AC Condensers on the roof area?
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Are extract fans on the roof area?
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Where is the key to get onto the roof?
Proposed Energy Saving Technologies
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Are Any of the following types of technology especisally suited to this store?
- Fan Speed Optimisation of Cold Rooms
- Solar
- Air Door or None heat over door curtain
- Hot Water Pump Optimisation
- Aerofoil on fridge cases
- LED Lighting Schemes
- Switching and Controls Upgrade
- Destratification of Air
