JES Affordable Warmth Survey

• Job Reference Number

• Property Address

• Customer Name

• Conducted on

  Date

• Prepared by

• Location
  Address

Details

• Address
  Address

• Customer Name

Identify hazards associated with works undertaken

• Drilling

• Cutting/Grinding

• Dust

• Lifting/Carrying

• Handling Waste

• Hot Works

• Cellar Access

• Floor Access

• Loft Access

• Boiler into Loft

• Use of Ladders

• Use of Stepladder

• Loose Carpets

• Asbestos

• Access/Egress

• Roof Works

• Confrontation

• Unsafe Structure

• Poor Hygiene

• Weather

Controls Required to Control Hazards Above

• Ear Muffs/Plugs

• Face Mask P3

• Gloves

• Safety Footwear

• Harness/Lanyard

• Lifting Straps

• Check Power Tools

• Eye Protection

• Safety Helmet

• Ladder Anti Slip

• Ladder Stand Off

• Remove Hazards

• Loft Boarding

• RCD

• A Frames

• Barrier Tape

• Rigid Barriers

• Sack Barrow

• Tidy Work Areas

• Lighting Unit

• Hi-Vis Clothing

• Fire Checks

• Cool Gel

• Heat Mats

• Fire Extinguisher

• 2 Person Lift

• Buddy Assist

• Addition Works Carried Out

• Is Buddy Assist Needed

  Yes

  No

• Called for buddy assist

• Contact Electrician to Wire System

  Yes

  No

  N/A

Signature

• Surveyor Signature

  Sign

Customer Property & Benefits

• Property Type

  House

  Bungalow

  Flat

  Maisonette

• Tenure

  Owner Occupier

  Tenant

• Benefit Type

  Child Tax Credits

  Working Tax Credits

  DLA

  Pension Credits

  Other

• Photo Evidence of Benefits (All Pages)

  Media

• If 'other' provide details here

• Property Size m2

Existing Boiler

• Heating System Type

  Fully Pumped

  Gravity

  One Pipe

  Pressurised

• Location Of Boiler

• Make and Model of Existing Gas Boiler (inc GC if accessible)

• Flue Type

  Open

  Balanced

  Fan Flued

  Vertical

• Asbestos Removal Needed

  Yes

  No

• Complete Asbestos Section

• Photo Evidence of Boiler

  Media

New Boiler

• Recommend Make and Model

• Boiler Type

  Combi

  Heat Only

  System

• Shower Compatible

• Flow Sufficient

• New Flue Type

  Standard

  Vertical

• Vertical Flashing

  Flat

  Pitched

• Plume Kit Needed?

• Terminal Guard Needed?

• Rear Flue Option (on selected boilers)

Gas Supply

• Is Gas Supply Adequate

  Yes

  No

• 15mm Run Needed?

• 22mm Run Needed?

• 28mm Run Needed?

• Photo of Gas Route

  Media

Condensate

• Termination

  Internal

  External

• Termination

  Gulley

  Soil Pipe

  Soak Away

• Termination

  Soil Pipe

  1 1/4

  1 1/2

• Condensate Pump Needed?

• Photo of Condensate Termination Point

  Media

Making Good

• Brick Up and Plaster Needed

  Yes

  No

• Comments

• Photos of Bricks needed and Location of Works

  Media

• High Level Making Good Needed?

  Yes

  No

• Comments

Electrics

• Main Earth Bonding Needed?

  Yes

  No

• Comments

• Fused Spur Needed

  Yes

  No

• Comments

Heating Controls

• Pump Needed?

  Yes

  No

• Reason for Replacement (controls to only be replaced if faulty)

• Photo Evidence

  Media

• Programmer Needed?

  Yes

  No

• Reason for Replacement (controls to only be replaced if faulty)

• Photo Evidence

  Media

• 3 Port Valve Needed?

  Yes

  No

• Reason for Replacement (controls to only be replaced if faulty)

• Photo Evidence

  Media

• 2 x 2 Port Valve Needed?

  Yes

  No

• Reason for Replacement (controls to only be replaced if faulty)

• Photo Evidence

  Media

• Room Thermostat Needed

  Yes

  No

• Reason for Replacement (controls to only be replaced if faulty)

• Photo Evidence

  Media

• Cylinder Thermostat Needed?

  Yes

  No

• Reason for Replacement (controls to only be replaced if faulty)

• Photo Evidence

  Media

• Cylinder To Be Replaced

  Yes

  No

• Reason for Replacement (cylinder to only be replaced if faulty)

• Photo Evidence

  Media

• TRVs Needed?

  Yes

  No

• 8mm TRVs Needed

• 10mm TRVs Needed

• 15mm TRVs Needed

• Addition Notes

CODES

• Type Of Replacement

  Select AA BB CC DD EE FF GG

  • AA
  • BB
  • CC
  • DD
  • EE
  • FF
  • GG

• Additional Items

  Select HH II JJ KK LL MM NN OO QQ SS TT UU VV

  • HH
  • II
  • JJ
  • KK
  • LL
  • MM
  • NN
  • OO
  • QQ
  • SS
  • TT
  • UU
  • VV

Labour Required

• Number of Engineers

  One

  Two

• Number of Days

  One

  Two

  Three

Signatures

• Client Signature

  Sign

• Surveyor Signature

  Sign

Asbestos Details (Address same as front cover)

• Has the client indicated that there may be asbestos within the property

  Yes

  No

• Location

• Photo of suspect material

  Media

• Is there any reason to suspect asbestos is present within the property?

  Yes

  No

• Location

• Photo of suspect material

  Media

Type of Asbestos

• What type of asbestos is present

  Select AIB Lagging Cement Products Textured Coating Gaskets / Seals Floor Coverings

  • AIB
  • Lagging
  • Cement Products
  • Textured Coating
  • Gaskets / Seals
  • Floor Coverings

• Is material in sound condition?

  Yes

  No

• Could the location be disturbed/damaged whilst works are been carried out?

  Yes

  No

• Type of Asbestos Removal Needed?

  Select Removal Drilling/Cutting Sampling/Testing Scrape

  • Removal
  • Drilling/Cutting
  • Sampling/Testing
  • Scrape

• Location of Works needed

• Photo of Material

  Media

Completion

• Customer Signature

  Sign

• Surveyor Signature

  Sign

Address from front cover

• Boiler Make and Model

• Code

  Select AA BB CC DD EE FF GG

  • AA
  • BB
  • CC
  • DD
  • EE
  • FF
  • GG

Flue

• Type of Flue

  Standard

  Vertical

• Vertical Adaptor

• Flat Roof Flashing

• Pitched Roof Flashing

• 1m Extension

• Quantity of 1m Extensions

• 90 Bends

• Quantity of 90 Bends

• 45 Bends

• Quantity of bends

• Quantity of Clips

• Flue Guard

• 1m Extension

• Quantity

• 90 Bend

• Quantity

• 45 Bend

• Quantity

• Clips

• Quantity

• Flue Deflector

• Quantity

• Plume Kit

• Plume Extension

• Quantity

• Plume 90 Bend

• Quantity

• Plume 45 Bend

• Quantity

Controls Danfoss

• Programmer / Thermostat Needed

  Yes

  No

• Time / Temperature Controls Needed

  Internal Clock (Combi Boiler)

  24 Hour Single Channel Programmer

  7 Day Programmer

  Room Stat Wired

  Programmable Room Stat Wireless

• Is Zone Control Needed

  Yes

  No

• Zone Control

  22mm 2-Port Valve

  22mm 3-Port Valve

  Y-Plan Control Pack

  S-Plan Control Pack

• Pump Needed

  Yes

  No

• Frost Protection Needed?

  Yes

  No

• Frost Protection

  Frost Stat

  Pipe Frost Stat

Cylinder

• Is Cylinder Needed

  Yes

  No

• Size of Cylinder

Condensate Waste Pack

• Colour of Pipe

  Black

  White

  Grey

• Condensate Pump Needed

• Internal Pack Needed

• External Pack Needed

• Soak away and Chippings

Additional Extras

• Shock Arrestor (For when Combi and Water Meter Present)

• 15mm Double Check Valve (for shock Arrestor)

• Pressure Relief Kit

• Filling Loop with Easy Turn Valves

• 15mm TRVs

• Quantity

• 15mm Lock Shield Valves

• Select from range

• MagnaClean Micropack (ECO Only)

• Adey MC1 Central Heating Protector

• Adey MC3 Central Heating Cleaner

• MagnaClean Test Pack

Fittings Pack

• JES Fittings Pack

  JES Pack 1 Conv to Conv

  JES Pack 2 Combi to Combi

  JES Pack 3 Conv/BBU to Combi

  JES Pack 4 BBU to Conv

• Additional Pipework

  Select 15mm 22mm

  • 15mm
  • 22mm

• 22mm Pipe

• 15mm Pipe

Radiators

• Radiators Needed?

  Yes

  No

• Size of Radiators Needed

Making Good

• Block

• Sand and Cement

• Plaster