Heating System Survey - V1

• Document No.

• Audit Title

  Select Technical Survey Materials List OFGEM Safety Informatiom

  • Technical Survey
  • Materials List
  • OFGEM
  • Safety Informatiom

• Attended By

  BPHL

  Green Deal Contracts

• Full Name of Surveyor

PROPERTY DETAILS

• Date

  Date

• Calling Card Left (Insert Time and Date) provide evidence of card being left

  Media

• JOB NUMBER

• Occupants Name

• Address
  Address

SAFETY INFORMATION

• Start Time?

  Date

• Photos of GDS 12 if hard copy

  Media
GDS12 - Survey

• Will the existing safety monitors provide adequate protection following the installation of the proposed measure

  YES

  NO

• Would any of these alarms need to be relocated?

  YES

  NO

• Would the installation work result in non-compliance within the building regulations in regards to:

• Materials

  YES

  NO

• Workmanship

  YES

  NO

• Structural

  YES

  NO

• Fire Safety

  YES

  NO

• Resistance to moisture

  YES

  NO

• Heat producing appliances

  YES

  NO

• Conservation of fuel and power

  YES

  NO

• CARBON MONOXIDE & OTHER SAFETY ALARMS
  HAVE THE ALARMS BEEN DATED IN THE LAST 12 MONTHS? RECORD BELOW
  

Safety Alarm

• Location

  Select Lounge Kitchen Landing Hallway Bedroom Dining Room

  • Lounge
  • Kitchen
  • Landing
  • Hallway
  • Bedroom
  • Dining Room

• Type of Alarm

  Select Mains Battery C02 Smoke Heat

  • Mains
  • Battery
  • C02
  • Smoke
  • Heat

• Date Tested

  Date

• Additional comments about this safety alarm

• PLEASE STATE BELOW ANY ISSUES THAT HAVE BEEN IDENTIFIED IN THIS PRE SURVEY THAT MAY NEED TO BE REFERRED TO THE GDP, SUCH AS PROTECTED SPECIES OR IF THE BUILDING APPEARS TO BE NON COMPLIANT WITH STATUTORY REGULATIONS.
  
  IS THERE ANY OTHER INFORMATION WHICH WOULD HELP THE INSTALLATION RUN MORE SMOOTHLY SUCH AS PARKING RESTRICTIONS OR STORAGE OF PLANT & MATERIALS?
  

• Other Information?

• Are there any presence of protected species at the property?

  YES

  NO

  UNKNOWN

• If "YES" State what, and if you deem necessary contact the office on 01302 745500 on whether to continue with the survey

• Any special customer requirements?

  Select Unsuitable Times Restrictions Special Needs Noise Restrictions Pets Other

  • Unsuitable Times
  • Restrictions
  • Special Needs
  • Noise Restrictions
  • Pets
  • Other

• If any of above chosen state more information

• Photo of GDF 34 RA if Hard Copy

  Media

• PAS 2030 - GDF 34 - RA

PAS 20 30 - GDF 34 - RA

• What are the Hazards?

  Select Falls from Ladders, Scaffolding Etc Risk to eyes when drilling Etc Electric Shock Asbestos within a work area General Site Hazards Visitors entering area

  • Falls from Ladders, Scaffolding Etc
  • Risk to eyes when drilling Etc
  • Electric Shock
  • Asbestos within a work area
  • General Site Hazards
  • Visitors entering area

• Who Might Be Harmed?

  Select Staff Contractors Site Visitors

  • Staff
  • Contractors
  • Site Visitors

• What is currently in place to prevent this?

  Yes

  No

  N/A

• Do you need to anything else to prevent this Risk?

  Yes

  No

  N/A

• Action by whom

  Select BPHL All Employees All Sub Contractors

  • BPHL
  • All Employees
  • All Sub Contractors

• Action by When?

  Completed

  1 Week

  1 Month

  6 Months

  12 Months

• Who Might be Harmed?

  Select Staff Contractors Site Visitors

  • Staff
  • Contractors
  • Site Visitors

• What is currently in place to prevent this?

  Yes

  No

  N/A

• Do you need anything else to prevent this risk.

  Yes

  No

  N/A

• Action by When?

  Completed

  1 Week

  1 Month

  6 Months

  12 Months

• Action by whom?

  Select BPHL All Employees All Sub Contractors

  • BPHL
  • All Employees
  • All Sub Contractors

TECHNICAL SURVEY

Technical Survey

• Type of Property

  Bungalow

  Flat / Maisonette

  House

• Property Configuration?

  Select Detached Semi Detached Mid Terrace End Terrace Ground Floor Upper Floor

  • Detached
  • Semi Detached
  • Mid Terrace
  • End Terrace
  • Ground Floor
  • Upper Floor

• Water Bonding Present?

  YES

  NO

  UNKNOWN

• Where "UNKNOWN" state more Information here.

• Image of Water Bonding

  Media

• Gas Bonding Present

  YES

  NO

  UNKNOWN

• Where "UNKOWN" state more information here.

• Image of Gas Bonding

  Media

• Main Earth Bonding Bonding Present?

  YES

  NO

  UNKNOWN

• Where "UNKOWN" state more information here.

• If possible please state type of Earth system present

  TT - Earth Spike

  TNCS - Combined N & E

  TNS - Separate Earth

• Image of main Earth Bonding

  Media

• RCD protection present?

  YES

  NO

• Please Note where a TT Earthing system has been selected above please also state here if no RCD Present?

• Photo of Fuse Board

  Media

• Has the property got a GAS Supply?

  YES

  NO

• Gas Pipe size at the Gas Meter?

  22MM

  15MM

  OTHER

• Location of GAS Meter?

• Existing Boiler Manufacturer & Model of Boiler?

• Location of Existing Boiler?

• Photo of Boiler

  Media

• Photo of boiler data plate

  Media

• What is is existing FLUE Type?

  Balanced

  Vertical

  Horizontal

  Fan

• Photo of Flue

  Media

• Photo of New Flue location

  Media

• Please state the boiler FAULT/S

• Estimated Cost of repair (£)

• Location of Stop tap?

• Type of Existing System?

  Select S or Y Plan Combi Condensing Combi Gravity BBU Other

  • S or Y Plan
  • Combi
  • Condensing Combi
  • Gravity
  • BBU
  • Other

• If "OTHER" Please state type of system

• Are there any building works required to the existing system if so please state?

• What materials are required to complete the building works stated above?

  Select Breeze Blocks Red Bricks Buff Bricks Other see photo

  • Breeze Blocks
  • Red Bricks
  • Buff Bricks
  • Other see photo

• Photo of brick colour for best brick match

  Media

• What is the pipe fabric & size to the existing radiators?

  Select Copper Plastic 15MM 10MM 8MM Other

  • Copper
  • Plastic
  • 15MM
  • 10MM
  • 8MM
  • Other

• Do any of the existing Radiators need replacing?

  YES

  NO

• Would the property require installation of a NEW Radiator & Pipe work?

  YES

  NO

• IT'S VERY IMPORTANT AT THIS STAGE TO INFORM THE TENNANT/OWNER THAT THESE MAY NOT BE COVERED BY THE GRANT AND PAYMENT OR GREENDEAL FINANCE MAY BE REQUIRED

• What are the floor structures DOWNSTAIRS?

  Select Wooden Boards Chipboard Solid

  • Wooden Boards
  • Chipboard
  • Solid

• What are the floor structures UPSTAIRS?

  Select Wooden Boards Chipboard Solid

  • Wooden Boards
  • Chipboard
  • Solid

• Please state any obstructions - eg Laminate Flooring in master bedroom

• How many HOT Water outlets are there?

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

• Are there any showers at the property, if Yes what Type?<br>

  NO

  Electric

  Pumped Electric

  Gravity

  Pressurised

• What is the water flow rate at the kitchen sink? (L/M)

• NEW SYSTEM INFORMATION

• What type of Installation will this property require?

  Swap

  Conversion

  Full System

• What Installation is required?

  Select S or Y Plan Combi Condensing Combi Gravity BBU Other

  • S or Y Plan
  • Combi
  • Condensing Combi
  • Gravity
  • BBU
  • Other

• Make of proposed new boiler?

  Glow worm Flexicom

  Potterton Pro Max

  Alpha ECO

  Other

• If " OTHER" Please state

• Size of proposed new boiler

  Select 12KW CONVENTIONAL 15KW CONVENTIONAL 18KW CONVENTIONAL 24KW COMBI 28KW COMBI 35KW COMBI

  • 12KW CONVENTIONAL
  • 15KW CONVENTIONAL
  • 18KW CONVENTIONAL
  • 24KW COMBI
  • 28KW COMBI
  • 35KW COMBI

• Location of NEW Boiler?

• Flue Type Required?

  Balanced

  Vertical

  Horizontal

  Fan

• What Type Condensate Installation is required?

  Bossed Internal

  Bossed External

  External Drain

  Soak Away

  Pumped

• What Heating Controls are Required?

  RF Programmable Stat

  Hard Wired Stat

  Full Plan Pack

• Where is the cylinder located?

  Cylinder Cupboard

  Loft

  Other

  N/A

• If "OTHER" state location

• Photos of Cylinder cupboard showing all controls

  Media

• State if you can think of any reason that this cylinder could not be removed from the property?

• Please add any additional information here that will assist the Plumbing engineer & or the Electrical Engineer with the Installation of the new heating system

• Additional Photos

  Media

• Finish Time?

  Date

MATERIALS LIST

• IF USING PAPER VERSION OF KIT LIST ADD CLEAR PHOTO OF ALL PAGES
  

• Photos of Material Kit list

  Media

• Materials List
  

Materials List

• Type of Boiler?

  Select 12KW CONVENTIONAL 15KW CONVENTIONAL 18KW CONVENTIONAL 24KW COMBI 28KW COMBI 35KW COMBI

  • 12KW CONVENTIONAL
  • 15KW CONVENTIONAL
  • 18KW CONVENTIONAL
  • 24KW COMBI
  • 28KW COMBI
  • 35KW COMBI

• Horizontal Flue

  YES

  NO

• Vertical Flue Terminal?

  YES

  NO

• PLEASE NOTE WHERE A VERTICAL FLUE IS REQUIRED RELEVANT RISK ASSESSMENT TO IMPLIMENTED
  

• Weather Slate

  YES

  NO

• 1M FLUE EXTENSION

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

• FLUE 90 DEGREE BEND

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

• FLUE 45 DEGREE BEND

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

• FLUE SUPPORT CLAMP

  Select 1 2 3 4 5 6 7 8 9 10 NO

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • NO

OFGEM V1

• PLEASE NOTE WE STILL REQUIRE A FULL PAGE PDF OF THIS OFGEM FORM UNTIL FURTHER NOTICE

• Will the OFGEM be sent as a separate attachment?

  YES

  NO

• Photo of All pages (Straight & Clear)

  Media

OCCUPANT SIGN OFF

• Print and Sign (Occupant)

  Sign

• Print and Sign (Engineer)

  Sign

• BY SIGNING THIS FORM YOU ARE CONFIRMING THE WORK HAS BEEN COMPLETED AND YOU ARE SATISFIED WITH THE REPAIR OR THE TEMPORARY RESOLUTION UNTIL THE REPAIR CAN BE COMPLETED.