Title Page
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Site conducted
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Audit Title
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Add media
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Conducted on
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Surveyed by
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Property address
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if flat what floor
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Client
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Address
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Resident name
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Telephone no.
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Property type
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How many occupants including Adults and Children
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How many bedrooms?
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How many bathrooms?
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Existing heating system
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Take photos of heating unit
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What is the Existing system fuel type?
- GSHP
- ASHP
- Oil
- LPG
- GAS
- Solid Fuel
What is the water pressure condition at the main cold water tap at kitchen sink?
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Water pressure?
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take photo of flow rate
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Proposed heating system
- GSHP
- ASHP
- Oil
- LPG
- GAS
- Solid Fuel
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BBU removal required?
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Fireplace removal block up required?
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Does the property have cavity wall insulation?
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Outside wall construction type?
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Roof insulation thickness
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TAKE PHOTO OF MEASUREMENT DEPTH OF INSULATION
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Are the windows Single double or triple glazed
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Window construction type?
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Loft tank to be removed?
Electrics
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Fuse board make & model?
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Take Photos of fuse board include MCB< RCDS
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What is the Fuse cut out rating, take a picture
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Electric meter MPAN number?
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photo of Meter Lable
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Take picture of main fuse
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is the Fuse
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Cost of electricity per KW usage
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Is it looped
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Is the service looped? is there 2 cables, 1 coming out (looped supply to Neighbour)
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Is there a smart meter?
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take Photo of smart meter installed?
Cylinder
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Depth Of Cupboard
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width Of Cupboard
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height Of Cupboard
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Image of cylinder cupboard
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Does the Cylinder need replacing
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What type of existing cylinder?
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can the D2 Pipework be exited to the exterior un-inhibited
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draw new location on plan and explain why
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D2 Discharge pipe work is it to G3 Regulations ?
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what alterations is required
Heat Pump
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Air source heat pump bracket type
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Position of air source heat pump
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Image of proposed location for heat pump
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ASHP soak away required
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Does the pipe work need to be upgraded to 28mm ( If pipe work is for Daikin needs to be 28) State amount
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Trunking Requirments
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Can the heat Pump be fitted 1m from the boundary fence/wall?
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- Yes
- No
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How many reflective surfaces?
- 1
- 2
- 3
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Distance to nearest Neighbouring habitual room
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From The assessment area what type of barrier is in place?
Time clock/ Stat
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Position of room thermostat
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Existing Time clock/Roomstat
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Existing heating
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How many storage heaters/radiators to be removed?
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Storage heater serial number (for asbestos info)
Lounge
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Existing Radiator size
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Hall
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Hall/Landing
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Delete to suit Hall or Landing
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Dining room
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Kitchen
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Bedroom 1
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Add media
Bedroom 2
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Add media
Bedroom 3
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Add media
Bedroom 4
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Add media
Bathroom 1
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Shower Type
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Will The Shower be Changed
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What tiles will need to be replaced as we can only do 1 or 2 best match possible.
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Add media
Bathroom 2/WC
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Shower Type
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Existing Radiator size
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Add media
Other
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Length
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width
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height
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window sizes
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Floor construction
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Number of outside walls
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Internal wall type
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Max space available for radiator location
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Add media
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Please detail job requirements
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Please enter job requirements
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Draw the floor plan
Surveyor declarations
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Customer informed that LCX are NOT responsible for decorating
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Customer informed carpets are NOT the responsibility of LCX.
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Customer to remove any laminate flooring prior to any work being carried out.
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Customer informed laminate flooring is NOT the responsibility of LCX
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Customer to remove any loose ornaments, mirrors, pictures etc. prior to work being carried out
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Customer informed any loose ornaments etc. are NOT the responsibility of LCX
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Customer informed if shower is NOT compatible with ASHP being installed
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Customer informed that shower is NOT the responsibility of LCX
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I have been offered the option of a Thermostatic shower instead of the Electric shower.
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I Have chosen the Thermostatic shower. I understand that the making good Tiles may not match exactly and cosmetically different.
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Surveyor signature
Customer declaration
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DECLARATION: I understand what work is due to be carried out and I agree to the position of the pipe-work, radiator positions, boiler location and the location of the room thermostat.
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I agree to the welfare facility’s to be used in my property.
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Customer Signature
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