Heelas Survey Form - Open System Boiler Change

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

Open System Boiler Change

• Heelas Heating and Renewables

  Yes

  No

  N/A

• Bayworth Chapel, Brumcombe Lane, Bayworth Oxon OX13 6QU www.heelasheating.co.uk dan.heelas@heelasheating.co.uk Office: 0844 8001682

  Yes

  No

  N/A

• Technical Survey Form

  Yes

  No

  N/A

• Boiler Change Open System Boiler

  Yes

  No

  N/A

• Customer Details:

• First Name:

• Date:

  Date

• Job Number:

• Last Name:

• Home Contact Number:

• Address:

• Other Contact Number:

• Please avoid the following times:

• Brief Description of Work to be Carried Out:

• Occupied

  Yes

  No

  N/A

• Unoccupied

  Yes

  No

  N/A

• House

  Yes

  No

  N/A

• Bungalow

  Yes

  No

  N/A

• Flat

  Yes

  No

  N/A

• Please Record any Damage to the Carpets and Flooring, Ceilings, Walls or Other:

• Customer's Signature:

  Sign

• Existing System:

• * Ensure the Customer Puts System into Full Operation Prior to Your Visit

  Yes

  No

  N/A

• Appliance Make:

• Boiler / System:

• Appliance Position:

• Flue:

• Fuel Type:

• Controls:

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Combination

  Yes

  No

  N/A

• Wall Mounted

  Yes

  No

  N/A

• Open

  Yes

  No

  N/A

• Gas

  Yes

  No

  N/A

• Integral Clock

  Yes

  No

  N/A

• System Boiler

  Yes

  No

  N/A

• Floor Mounted

  Yes

  No

  N/A

• Fanned

  Yes

  No

  N/A

• Oil

  Yes

  No

  N/A

• Room Stat

  Yes

  No

  N/A

• Appliance Model:

• Open Vented

  Yes

  No

  N/A

• Back Boiler

  Yes

  No

  N/A

• Balanced

  Yes

  No

  N/A

• LPG

  Yes

  No

  N/A

• Trv's

  Yes

  No

  N/A

• Storage Htrs

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Vertex

  Yes

  No

  N/A

• Solid Fuel

  Yes

  No

  N/A

• 'S' Plan

  Yes

  No

  N/A

• Fully Pumped

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Electric

  Yes

  No

  N/A

• 'Y' Plan

  Yes

  No

  N/A

• Output (Kw):

• Gravity

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Energy Man

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Zinc or '1' Pipe

  Yes

  No

  N/A

• Cylinder Type:

• Other

  Yes

  No

  N/A

• New System:

• Appliance Make:

• Model:

• Output:

• How Far is the Boiler Moving Position?

  Yes

  No

  N/A

• Flue:

• Gas Supply:

• Condense:

• Controls:

Flue Direction:

• Other Flue Considerations:

• Upgrade:

• Run:

• Arrangement:

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Tick

  Yes

  No

  N/A

• Integral Timer

  Yes

  No

  N/A

• Wireless?

  Yes

  No

  N/A

• Rear

  Yes

  No

  N/A

• Pitched Tile

  Yes

  No

  N/A

• To:

• 22mm

  Yes

  No

  N/A

• Internal

  Yes

  No

  N/A

• External Timer

  Yes

  No

  N/A

• 'S' Plan

  Yes

  No

  N/A

• Side

  Yes

  No

  N/A

• Adj. Pitched Tile

  Yes

  No

  N/A

• 28mm

  Yes

  No

  N/A

• External

  Yes

  No

  N/A

• Room T'stat

  Yes

  No

  N/A

• 'Y' Plan

  Yes

  No

  N/A

• Vertical

  Yes

  No

  N/A

• Lead Slate

  Yes

  No

  N/A

• Pumped

  Yes

  No

  N/A

• Upgrade Vent/Feed Config?

  Yes

  No

  N/A

• Spacer Kit

  Yes

  No

  N/A

• Flat Roof Kit

  Yes

  No

  N/A

• Soakaway

  Yes

  No

  N/A

• Convert to Fully Pumped?

  Yes

  No

  N/A

• Length of

• New Trv's

  Yes

  No

  N/A

• L/Shields

  Yes

  No

  N/A

• Length of Flue:

• Tick

  Yes

  No

  N/A

• ReRun?

  Yes

  No

  N/A

• Distance?

• Tick

  Yes

  No

  N/A

• Plume Kit:

• Standard:

• Any Additional Comments:

• Tick

  Yes

  No

  N/A

• Length if

• Qty

  Yes

  No

  N/A

• White Kit

  Yes

  No

  N/A

• Longer:

• Black Kit

  Yes

  No

  N/A

• Water Supply and Quality:

• Water Storage

  Yes

  No

  N/A

• Water Treatment:

• Tick

  Yes

  No

  N/A

• Water Softeners:

• New Cylinder / Storage Vessel Required?

  Yes

  No

  N/A

• Hot & Cold Flush

  Yes

  No

  N/A

• Full Powerflush

  Yes

  No

  N/A

• NOTE:

• Manufacturer:

• Make / Model:

• Inhibitor

  Yes

  No

  N/A

• Magnaclean

  Yes

  No

  N/A

• Water Softeners are not

  Yes

  No

  N/A

• Scale Reducer

  Yes

  No

  N/A

• Compatible with Aluminium

  Yes

  No

  N/A

• Heat Exchangers; Ensure

  Yes

  No

  N/A

• Size?

  Yes

  No

  N/A

• Litres:

• Other:

• Water Supply to the System

  Yes

  No

  N/A

• is UnTreated

  Yes

  No

  N/A

• Type i.e. Unvented:

• Technical Survey Form

  Yes

  No

  N/A

• Heelas Heating and Renewables

  Yes

  No

  N/A

• Bayworth Chapel, Brumcombe Lane, Bayworth Oxon OX13 6QU www.heelasheating.co.uk dan.heelas@heelasheating.co.uk Office: 0844 8001682

  Yes

  No

  N/A

• Boiler Change Open System Boiler

  Yes

  No

  N/A

• Electrical:

• Power Supply:

• Tick

  Yes

  No

  N/A

• Bonding:

• Is the Existing Power Supply Adequate?

  Yes

  No

  N/A

• Do we need to Fit / Upgrade Mains Equipotential Bonding?

  Yes

  No

  N/A

• Do we need to Fit / Upgrade Supplementary Bonding?

  Yes

  No

  N/A

• Is there a Fused Spur <1m from Boiler Position?

  Yes

  No

  N/A

• Is a New Fused Spur Required?

  Yes

  No

  N/A

• Certification:

• Is there an Adjacent Immersion Point Present?

  Yes

  No

  N/A

• Part 'P' Required?

  Yes

  No

  N/A

• Is Additional Pump OverRun Wiring Required?

  Yes

  No

  N/A

• Minor Works Certification Required?

  Yes

  No

  N/A

• Electrician:

• Any Additional Comments:

• Do we need to Contract the Services

  Yes

  No

  N/A

• of our Electrician?

  Yes

  No

  N/A

• Building Work:

• Flue Hole:

• Tick

  Yes

  No

  N/A

• Explain any Other Remedial Work Required e.g. Boxing:

• Will the Engineer be able to Make Good?

  Yes

  No

  N/A

• Old Flue Holes to be Made Good?

  Yes

  No

  N/A

• Balanced Flue

  Yes

  No

  N/A

• Fanned Flue

  Yes

  No

  N/A

• Builder:

• Do we need to Contract the Services

  Yes

  No

  N/A

• of our Builder?

  Yes

  No

  N/A

• Asbestos:

• IMPORTANT

  Yes

  No

  N/A

• If Asbestos or an Appliance Deemed to Contain Asbestos is Suspected, then an 'Asbestos Risk Survey Sheet' must be Completed

  Yes

  No

  N/A

• and Notification to your Line Manager Must be Made

  Yes

  No

  N/A

• If in any Doubt of the Company Procedure, you must Liase with your 'Health and Safety' Advisor Immediately

  Yes

  No

  N/A

• Working at Heights:

• IMPORTANT

  Yes

  No

  N/A

• Additional Equipment:

• Tick

  Yes

  No

  N/A

• Any Additional Comments:

• Ladders

  Yes

  No

  N/A

• Scaffolding

  Yes

  No

  N/A

• Tower

  Yes

  No

  N/A

• Scaffolder:

• Do we need to Contract the Services

  Yes

  No

  N/A

• of our Scaffolder?

  Yes

  No

  N/A

• * Please use a 'Working at Heights Form'

  Yes

  No

  N/A

• Lifting and Handling:

• IMPORTANT

  Yes

  No

  N/A

• Additional Person Required:

• Time:

  Date

• Any Additional Comments:

• Manual Handling

  Yes

  No

  N/A

• hrs

  Yes

  No

  N/A

• Ladder Work

  Yes

  No

  N/A

• hrs

  Yes

  No

  N/A

• Appliance Handling

  Yes

  No

  N/A

• hrs

  Yes

  No

  N/A

• Vertical Flue Work

  Yes

  No

  N/A

• hrs

  Yes

  No

  N/A

• Does the Primary Engineer have a Sack Truck?

  Yes

  No

  N/A

• Additional Questions:

• Labour and Waste

  Yes

  No

  N/A

• Can Materials Be Delivered the Day Before Commencement of Works?

  Yes

  No

  N/A

• Estimated Labour Time Prior to Material / Pack Pricing

  Yes

  No

  N/A

• Engineer 1

  Yes

  No

  N/A

• hrs

  Yes

  No

  N/A

• Engineer 2

  Yes

  No

  N/A

• hrs

  Yes

  No

  N/A

• Estimated Total Travel Time

  Date

• Engineer 1

  Yes

  No

  N/A

• hrs

  Yes

  No

  N/A

• Engineer 2

  Yes

  No

  N/A

• hrs

  Yes

  No

  N/A

• Estimated Total Labour Time Prior to Material/Pack Pricing

  Yes

  No

  N/A

• Total

• hrs

  Yes

  No

  N/A

• Where is the most Convenient Place to Store the Waste until Collection?

• Surveyor:

• I have completed a 'Quotation Variation Form' for any shortfalls from the initial sales visit and/or raised a separate job for any other

  Yes

  No

  N/A

• works that will take place at the same time of installation. I have pretreated the central heating system

  Yes

  No

  N/A

• Name:

• Signature:

  Sign

• Date:

  Date

Sheet