Title Page

Details

  • Conducted on

  • Prepared by

  • Client and Tenure

  • Who?

  • Survey Type

  • First Line of Address

  • Front Elevation Photo

  • What3Words Location

  • GPS

Dynamic Risk Assessment

Access Assessment

  • Do you give consent for us to carry out works within your property ?

  • Reasoning?

  • Is there an overhead main power cable to the property that needs sheathing before scaffold erected?

  • Photographic Evidence

  • Are there any conservatories or out buildings that require a scaffold bridge for this job?

  • Are there any restrictions to the property i.e. Low bridge, neighbours access required ?

  • Comments

  • Photographic evidence

  • Is the property location a main pedestrian route and/or a public walkway ?

  • Comments

  • Photographic evidence

  • Is parking available, adequate for the size of vehicle and close to the property ?

  • Comments,

  • Photographic evidence

  • Do parking restrictions exist i.e. Residents parking ?

  • Comments

  • Photographic evidence

  • Will the proposed works affect neighbouring properties ?

  • Comments

  • Photographic evidence

  • Has the neighbouring property been notified of the imminent works?

  • Date of notification given-

Occupant Assessment

  • Is the property in a suitable condition for the proposed works to be carried out ?

  • Comments

  • Photographic evidence

  • Is the property highlighted as flagged or at risk ?

  • Comments

  • Do the occupants have any physical disabilities that pose any significant risks ?

  • Comments

  • Do the occupants have any learning difficulties where our activities may pose any significant risks ?

  • Comments

  • Are there any potential risks regarding minors in the property ?

  • Comments

  • Are there any potential risks regarding pets in the property ?

  • Comments

  • Is the property high risk of biological waste or vermin ?

  • Comments

  • Photographic evidence

  • Is the property at high risk of hypodermic needles ?

  • Comments

Asbestos Assessment

  • Are we in receipt of or have access to the asbestos survey or register for this property ?

  • Asbestos Assessment Needs to be Checked

  • Comments

  • Has asbestos been identified ?

  • Comments

  • Photographic evidence

Resident and Occupancy Details

Customer Details

  • Resident Name

  • Resident Contact Number

  • Resident Email

  • Best Days for Installation / Days to Avoid

  • Current Energy Supplier

  • Which Supplier?

  • Is More Detailed Occupancy Information Required?

  • Is the occupancy considered typical for the property?

  • Over or Under Occupied?

  • How many people live in the property?

  • Is there a thermostat?

  • Is the thermostat maintained at a typical temperature?

  • Is this due to the thermostat temperature being considered higher or lower than typical?

  • Is the heating pattern considered typical for the property?

  • Is this due to the heating pattern being considered higher or lower than typical?

  • Does the customer utilise all heat emitters within each room that contains them?

  • Has the customer been made aware of the process of gathering personal data and relevant Data Protection policies?

  • Can you identify any existing Energy Efficiency Measures that have been installed?

  • Current Energy Efficiency Measures

  • What Other Measures?

  • Do you believe that all current Energy Efficiency Measures are being used correctly?

  • Have you undertaken a separate occupancy assessment

  • Which assessment version?

  • Specify

Basic Property Details

Basic Property Details

  • Property Type

  • What Type

  • Attachment

  • What Type

  • Building Finish

  • What Type

  • Construction Type

  • Structural Condition of Wall

  • Structural Issues/Remedial Works Required

  • Details of remedial works and photos

  • Photo of remedial works required

  • Age Band

  • Listed Building / Conservation Area

  • Has the Council Website Been Checked at Point of Survey?

  • Should the planning department be notified?

  • Number of Storeys

  • Floor Construction Type

  • Structural Condition of Floor

  • Structural Condition of Roof

  • Internal Inspection of Building Completed

  • What Condition is the Inside

  • Photographic Evidence

  • What Rooms?

  • Number of Bedrooms

  • Number of Bathrooms

  • Main Heating Type?

  • Boiler Type

  • Type?

  • Boiler Model

  • What Model?

  • Boiler Location

  • What Location?

  • Heating Controls Type

  • Heating Controls Location

  • Where

  • New Heating Control Proposed Location

  • Where?

  • Photographic Evidence

  • What Type

  • What Type

  • Heat Pump Type

  • Secondary Heat source?

  • Photographic Evidence

  • Safety Monitors Present

  • Photographic Evidence

  • At the time of attending the property did you witness any protected animals/did the resident make you aware of any protected animals? E.G. Bats

  • Give Details

  • On Site Parking

  • Where?

  • Any Access Issues

  • What Issues are Present

Loft Insulation Survey

Loft Insulation Survey

  • Is Loft Insulation a Proposed Measure?

  • Is the Loft Accessible?

  • Is loft to be insulated.

  • Photo of loft and access point

  • Loft Hatch Size?

  • Area to be insulated.

  • Existing Depth.

  • Photo of existing depth.

  • Minimum Depth to be achieved

  • Pipes and Tanks Present

  • Details and size of tanks to be insulated

  • Number and length of pipes to be lagged

  • Check on site

  • Down lights present in ceiling?

  • Details of down lights, how many and there current location

  • Do they have halogen bulbs fitted.

  • Can you see the IP rating on the casing?

  • Please take a photo of the down light IP rating.

  • Are there any existing down light covers fitted?

  • If YES are they fire rated covers?

  • Electrical wiring free from visual defects?

  • Any evidence of electric wiring trapped between insulation?

  • Are there any high voltage cable's in the loft space.

  • If YES please select the type of cable in the loft space.

  • In your opinion should loft be Rolled or Blown?

  • Loft Height at Centre

  • Does a steel combustion flue pass through the loft space?

  • Relay of Insulation Required?

  • Estimate of relaying time allocation

  • Loft hatch needing D/P

  • Does the hatch need to be replaced?

  • Loft vents required

  • Areas to be omitted

  • What Areas?

  • Does the loft have any boarding?

  • If YES can we insulate at lease 2/3 of the loft space?

  • Has the boarded area got insulation under it?

  • If not insulated under, are the joist tunnels tightly sealed with insulation at the ends?

  • Is roof eaves insulation present

  • Can the insulation be undertaken through the loft space

  • How should it be installed?

  • Rafter depth (mm)

  • What is the roof covering?

  • Breathable felt fitted?

  • Is the specification available?

  • Walkway required

  • Details of walkway

  • What is Required?

  • Loft clearance

  • Details of loft clearance

  • Estimate of loft clearance time allocation

  • Why?

  • What?

Cavity Wall Insulation Survey

Cavity Wall Survey

  • Is Cavity Wall Insulation a Proposed Measure?

  • Required material.

  • What type?

  • Total area to be insulated.

  • Any Omitted Areas

  • Total area to be omitted.

  • Photos of omitted areas.

  • Material to be Extracted

  • Average Cavity Depth

  • Please take a photo of the overall cavity width across a door or window reveal.

  • Please select the type of ventilation present, including extraction ventilation and trickle vents.

  • Please take a photo of all vents and extraction fans fitted within the property including at least 2 photos of window trickle vents.

  • Do any of the air vents require sleeving or sealing up before installing the cavities.

  • If yes please select the air vents that require sleeving or sealing up.

  • Installer to check

  • Adjoining properties insulated ?

  • Is it included in this project?

  • Number and length of Cavity brushes required (total in m)

  • Location of Flue

  • Combustion core vent required.

  • Number of combustion vents required.

  • Why?

Front Elevation.

  • Cavity Depth.

  • Photos of tape measure in the cavity.

  • Photo of the elevation inc Boroscope hole marked with an S.

  • Borescope Photos

  • Photo of DPC showing a tape measure

  • Is a French Drain Required?

  • Is the DPC bridged at any point on this elevation?

  • Comments

Rear Elevation

  • Cavity Depth

  • Photos of tape measure in the cavity.

  • Photo of the elevation inc Boroscope hole marked with an S.

  • Borescope Photos

  • Photo of DPC showing a tape measure

  • Is a French Drain Required?

  • Is the DPC bridged at any point on this elevation?

  • Comments

Right hand elevation

  • Is there a right hand elevation on this property

  • Cavity Depth

  • Photos of tape measure in the cavity.

  • Photo of the elevation inc Boroscope hole marked with an S.

  • Borescope Photos

  • Photo of DPC showing a tape measure

  • Is a French Drain Required?

  • Is the DPC bridged at any point on this elevation?

  • Comments

Left hand elevation

  • Is there a left hand elevation on this property

  • Cavity Depth

  • Photos of tape measure in the cavity.

  • Photo of the elevation inc Boroscope hole marked with an S.

  • Borescope Photos

  • Photo of DPC showing a tape measure

  • Is a French Drain Required?

  • Is the DPC bridged at any point on this elevation?

  • Comments

Building extensions

  • Is there an extension on this property

  • Cavity Depth

  • Photos of tape measure in the cavity on each elevation.

  • Photo of the elevation inc Boroscope hole marked with an S.

  • Borescope Photos

  • Photo of DPC showing a tape measure

  • Is a French Drain Required?

  • Is the DPC bridged at any point on this elevation?

  • Comments

Additional Ventilation Questions if Funding is Available

Funding Questions

  • Is Funding Available?

  • Does the property meet the minimum acceptable ventilation requirements set out in PAS 2035?

  • Does the cooker have a hood which ventilates to the outside?

  • Is there an airing cupboard or drying room that is ventilated to the outside?

  • Is there a tumble dryer which is vented to the outside of the property?

  • Do all wet rooms have as a minimum some from of passive or purge ventilation? (opening windows, air bricks or trickle vents)

  • Do all wet rooms have closing doors?

  • Is there a passive ventilation system?

  • Is there a mechanical ventilation system? (Continuous mechanical extract ventilation, Continuous mechanical ventilation with heat recovery)

  • Is there evidence of intermittent heating to parts of the property ?e.g TRV's being turned down too low to unused areas.

  • Are there appropriate controls in place to regulate the heating in the property?(thermostat, programmer etc)

  • Is the thermostat set to a minimum of 10 Celsius in all parts of the property that are heated?

  • Is there evidence of clothes being dried in the property?

  • Are there more bedrooms than occupants?

  • Is there single glazing at the property?

  • Has the importance of behaviour to moisture and condensation been explained to the occupants and left behind?

  • Is there a condensation calculation required? If so what elements?

External Wall Insulation Survey

External Wall Insulation Survey

  • Is an external wall insulation survey required?

  • Number of elevations to be treated

  • Does the wall have cavity insulation?

  • If no, has the cavity been sealed at the perimeter?

  • Need for fire separation of the compartments/Boundaries defined:

  • EEM Design: Accounts for the Building Regulation requirements for fire:

EEM DESIGN:

  • Design accounts for building exposure:

  • Design accounts for loading in service e.g Impact:

  • Comments

  • Design eliminates thermal bridging:

  • Design minimises thermal bridging

Existing Finishes: External/Internal

  • Agrees with Retro fit Assessment and Design

  • External Finishes

  • Please state other type of finish.

  • Internal: Colours & Textures

  • Other internal finishes please specify:

  • Comments:

Through Wall Construction

  • Internal to external surface layers

  • Overall Wall Thickness

  • Photo of wall thickness

  • Layer 1

  • Layer 2

  • Layer 3

  • Layer 4

  • Layer 5

  • Layer 6

  • Layer 7

  • Has a second through wall construction been identified ?

  • Overall Wall Thickness

  • Photo of wall thickness

  • Layer 1

  • Layer 2

  • Layer 3

  • Layer 4

  • Layer 5

  • Layer 6

  • Layer 7

  • Has a third through wall construction been identified ?

  • Overall Wall Thickness

  • Photo of wall thickness

  • Layer 1

  • Layer 2

  • Layer 3

  • Layer 4

  • Layer 5

  • Layer 6

  • Layer 7

Property Elevation Photos

  • Which Elevations exist on this property

  • Photos

Property Measurements:

  • Property Sketch Photos with Measures

Enabling

  • Satellite Dish works (qty)

  • TV Ariel (qty)

  • External Lights (qty)

  • Alarms (qty)

  • CCTV (qty)

  • Electric Cables (description and lm)

  • Satellite Cables (lm)

  • Electric Box (Type and qty)

  • BT Box (qty)

  • Gas Box (Type and qty)

  • Gas Flue (position and qty)

  • Gas Pipework (lm)

  • Condense Pipework (lm)

  • PRV (qty)

  • Overflow (qty)

  • External Tap (qty)

  • Downpipes (Number of downpipes and lm)

  • Soil and Vent Pipe (connections and lm)

  • Vent Pipe (lm)

  • Through soffit (Y/N)

  • Gates (Material and qty)

  • Fence panels (material and qty)

  • Fence posts (material and qty)

  • Walls (construction type and description)

  • Canopy/Porch (material and qty)

  • Vegetation (day work estimation)

  • Handrail (material and lm/brackets)

  • Grab rails (material and qty)

  • Scaffolding Bridge (qty)

  • Window Cills (over or under)

  • Insulated Plinth Detail (lm)

STRUCTURAL DEFECTS (E.g. Cracking, subsidence,weak or cored components):

  • Is there any evidence of structural defects ?

  • What are the Details?

  • Requires Competent Person e.g. Structural Engineer

  • Photos of Structural Defects

  • EEM Design:

  • Structural repairs included in the design before works start

  • Structural repair to be carried out by others before works start

  • Site pull-out tests undertaken for mechanical fixings

  • System fixing design calculated for all loading conditions ( wind,system weight etc.)

  • Design eliminates thermal bridging

  • Design minimises thermal bridging

  • Interface design details( weather seals etc.) comply with requirements of PAS 2030 2019

EXISTING RENDER:

  • Comments:

  • Comments on apparent defects

  • Agrees with Retrofit Assessment/Design

  • Photo(s)

  • EEM Design:

  • Requires removal, partial removal, repair

  • Render repair included in the design

  • Render repair measure to be carried out by others prior to works.

PRESENCE OF DAMP (RISING, PENETRATING OR CONDENSATION):

  • Comments

  • Comments on damp

  • Photo(s)

  • EEM Design:

  • Damp treatment included in the design

  • Damp treatment measure to be carried out by others prior to works starting.

FROST DAMAGE:

  • Comments

  • Photo(s)

  • EEM Design:

  • Frost repair included in the design

  • Frost repair measure to be carried out before

DETAIL/LOCATION OF MOVEMENT JOINTS:

  • Are there Movement Joints

  • Comments of movement joints

  • Photo(s)

  • EEM Design:

  • Included in the design

  • Design eliminates Thermal bridging

  • Design minimises Thermal bridging

  • Interface design details (weather seals etc.) comply with the requirements of PAS 2030 2019

MOSS/LICHEN/MOULD/IVY or EFFLORESCENCE

  • Is MOSS/LICHEN/MOULD/IVY or EFFLORESCENCE present

  • Comments of growth

  • Photo(s)

  • EEM Design:

  • Remediation included in the design

  • Design eliminates cold bridging

  • Design minimises cold bridging

  • Interface design details (weather seals etc.) comply with requirements of PAS 2030 2017

WINDOWS/DOOR MATERIAL:(Timber/PVC/Other):

  • Photo(s):

  • Window material type

  • Window Renewal

  • Door material type

  • External Door Renewal

  • EEM Design:

  • Design eliminates Thermal bridging

  • Design minimises Thermal bridging

  • Interface design details (weather seals around cill, window frame etc.) comply with requirements of PAS 2030/2019

  • Comments:

EXTERNAL SERVICES/ATTACHMENTS TO THE WALLS e.g (Satellite dish, lights):

  • Photo(s)

  • EEM Design:

  • Design eliminates Thermal bridging

  • Design minimises Thermal bridging

  • Interface design details (weather seals around cill, window frame etc) comply with requirements of PAS 2030/2019

  • Comments:

EXTERNAL ELECTRICAL CABLES/EQUIPMENT:

  • Photo(s)

  • EEM Design:

  • Design eliminates Thermal bridging

  • Design minimises Thermal bridging

  • Design details (Penetration,fixings, weather seals etc.) comply with requirements of PAS 2030 2019

  • Comments:

EWI ABUTMENT TO EAVES & ROOFS:

  • Photo(s)

  • EEM Design:

  • Design eliminates Thermal bridging (full continuity between wall and the roof insulation)

  • Design minimises Thermal bridging (partial continuity between wall and roof insulation)

  • Interface design details (weather seals etc.) comply with the requirements of PAS 2030/2019

  • Comments:

EWI ABUTMENT TO OTHER STRUCTURES (Conservatories extensions, garden walls, gate posts etc):

  • Photo(s)

  • EEM Design:

  • Design eliminates Thermal bridging

  • Design minimises Thermal bridging

  • Interface design details (weather seals etc.) comply with requirements of PAS 2030/2019

  • Comments:

RAIN WATER AND DRAINAGE PIPES:

  • Photo(s):

  • EEM Design:

  • Can existing Pipework be moved ?

  • Design eliminates Thermal bridging

  • Design minimises Thermal bridging

  • Design details (Penetrations, fixings, weather seals, mounting blocks etc.) comply with the requirements of PAS 2030/2019

  • Comments:

DAMP PROOF COURSE(DPC) PROVISION AND LOCATION:

  • Photo(s) of DPC (Each Elevation)

  • EEM Design:

  • Design eliminates Thermal bridging

  • Design minimises Thermal bridging

  • Design details (E.g Insulated plinth below DPC) complies with requirements of PAS 2030/2019

  • Comments (including any insulated plinth detail and location)

ARCHITECTURAL FEATURES (e.g. protruding stone work, tile sills, soldier courses):

  • Photo(s)

  • EEM Design:

  • Design eliminates Thermal bridging

  • Design minimises Thermal bridging

  • Design details (Penetrations, fixings, weather seals,etc.) comply with requirements of PAS 2030 2019

  • Comments:

Ventilation Survey

Ventilation Survey

  • Is a Ventilation Survey Required?

  • Living Room?

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Dining Room?

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Bedroom 1?

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Bedroom 2?

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Bedroom 3?

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Bedroom 4?

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Bedroom 5?

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Study?

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Other Specify?

  • What Room

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Kitchen?

  • Has Extractor Fan

  • Is it an in Wall or Window Extractor Fan

  • Is the Extractor Fan Working

  • Extractor Fan Flow Rate

  • Requirements

  • Does it Meet the Requirements

  • Does it Require Replacement?

  • Does it Require Replacement

  • New Extractor to be Installed in Kitchen

  • New Extractor to be Fitted in Wall or Window

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • Bathroom?

  • Has Extractor Fan

  • Is it an in Wall or Window Extractor Fan

  • Is the Extractor Fan Working

  • Extractor Fan Flow Rate

  • Requirements

  • Does it Meet the Requirements

  • Does it Require Replacement?

  • Does it Require Replacement

  • New Extractor to be Installed in Bathroom

  • New Extractor to be Fitted in Wall or Window

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • W/C?

  • Has Extractor Fan

  • Is it an in Wall or Window Extractor Fan

  • Is the Extractor Fan Working

  • Extractor Fan Flow Rate

  • Requirements

  • Does it Meet the Requirements

  • Does it Require Replacement?

  • Does it Require Replacement

  • Has Required Door Undercuts

  • Door Requires Trimming

  • Has Purge Ventilation

  • Has Trickle Vents / Background Ventilation

  • Photos

  • New Extractor to be Fitted in Wall or Window

PV Survey

PV Survey

  • Is a PV Survey Required

Roof Type

  • Roof Style

  • Tile Type

  • Tile Description (clay or concrete, interlocking or lapped)

Roofing and Scaffold

  • Scaffold Location

  • Height of Eaves? (Metres)

  • Required Access to rear?

  • Location of rear access

  • Where?

  • Length along the gutter (Metres)

  • Height up the roof slope (Metres)

  • Pitch ° degrees

  • Height of Roof Above Eaves? (Metres)

  • Front of Property Orientation in ° Degrees

  • Is the Loft Accessible?

  • Roof type

  • Size of Purlin (mm)

  • Number of Purlin Supports Front

  • Number of Purlin Supports Back

  • Number of Purlin Supports Side

  • Maximum Unsupported Rafter Length (Metres)

  • Size of Rafters/Top Chord of Truss (mm)

  • Number of Trusses/Rafters

  • Rafter/Truss Centres (mm)

  • Timber Condtion

  • Felt Condition

  • Observations (e.g holes in felt around gas flue)

  • Loft Condition

  • Is There a Smoke Detector in the Loft

  • New Smoke Detector to be Fitted in Loft

  • What is the Make and Model

  • Does it Need Replacing With Client Specified Model

  • Any Issues With Loft access

  • What Issues?

  • Loft Headroom Meters

  • Temporary Loft Light Required

  • Temporary Loft Walkway Required

  • Why?

  • Notes

Electrics

  • Consumer Unit Make and Model

  • What Brand?

  • Breaker Type

  • Location

  • Where?

  • Distribution Board Upgrade Required

  • Spare Way for PV

  • Additional Garage DB Required for PV

  • Earthing to Gas Meter

  • Gas Meter Location

  • Where?

  • Earthing to Water Main

  • Water Main Location

  • Where?

  • Earthing Type

Import Meter Type

  • Meter Type

  • Does Meter require changing?

  • Make and Model of Meter

  • What Model?

  • Meter Serial Number

  • Is the MPAN Number Present

  • What is the MPAN Number

  • Is there room for the 4 pole isolation switch next to the existing meter

  • Import Meter Location

  • Where is it?

  • Generation Meter Location (Proposed)

  • Where shoud it be located?

Photovoltaic System Proposed

  • Proposed Inverter Location

  • Where should is be located?

  • Can a 600 x 780 board fit on wall and through internal roof access

  • Approx AC cable run length from Consumer Unit to Inverter

  • Cellular Networks Checked with Good Signal?

  • Will there be Battery Storage

  • Size of Proposed Area

  • Distance to DB

  • Proposed Battery Location

  • Photo of Proposed Location

Photo Checklist

  • Property Elevations, Front Door & Scaffold Access

  • Suitable Roof Elevation Close Up including gutter

  • Proposed Inverter Location

  • Roof Void if relevant including TV ariel

  • Consumer Unit and Close up of Breakers

  • Electricity Meter & Mains Fuse / Earth in Meter Box

  • Water main bond

  • Gas Main bond (if applicable)

  • Satellite dish (if any) including closeup of bracket

Shading

  • Has SunEye Survey been completed

  • Why?

  • Notes

  • Notes

Air Source Heat Pump Survey

  • Is an Air Source Heat Pump Survey Required

  • Water Pressure

  • BBU Removal Required

  • Photographic Evidence

  • Fireplace Removal/Block up Required

  • Photographic Evidence

  • Window Material Type

  • Loft Water Tank Removal

  • Electricity Cost per kWh

  • Fuse Board and Main Fuse Cut Out Rating

  • Main Fuse Cut Out Rating

  • Is the mains service looped? (2 cables, 1 coming out to neighbours propoerty)

  • Photographic Evidence

  • Smart Meter Installed?

  • Electric Meter Photographic Evidence

Cylinder Cupboard

  • Door Size

  • Cupboard Depth, Width & Height

  • Photographic Evidence of Cylinder Cupboard

  • What Size of Cylinder Will Fit

  • How will the Dischage Pipe Route to Outside be done

  • Existing Cylinder Type

Proposed Heat Pump

  • Bracket Type

  • Proposed Location

  • Proposed Location Photo

  • ASHP Soak Away Required

  • Recommendation

  • Pipework Upgrade to 28mm Required? (Daikin Requires 28mm). State length.

  • Trunking Requirements

  • Can the External Unit be Installed 1m from Boundary

  • Recommended Solution

  • How Many Reflective Surfaces

  • Distance to Nearest Habitable Room

  • From Assessment Area What Barrier is in Place

Thermostat

  • Current Thermostat Position

  • Photo of Current Location

  • Proposed Thermostat Position

  • Photo of Proposed Location

Existing Heating

  • How Many Storage Heaters/Radiators Need to be Removed?

  • Storage Heater Serial Number (For Asbestos Purposes)

Room Details

  • Floor Construction Type

  • Floorplan Showing Individual Room Sizes and Ceiling Height

  • Living Room

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Hallway

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Dining Room

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Upper Floor Hallway/Landing

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Bedroom 1

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Bedroom 2

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Bedroom 3

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Bedroom 4

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Bedroom 5

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Study

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Kitchen

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Bathroom

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • W/C

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Other Specify

  • What Room

  • Window Sizes

  • Number of Outside Walls

  • Internal Wall Type

  • Max Space Available for Radiator (Length, Height)

  • Existing Radiator Size

  • Photo

  • Job Requirements

Declarations

Customer Informed

  • LCX Not Responsible for Decorating

  • LCX Not responsible for Carpets

  • LCX Not Responsible for Laminate Flooring and Customer must Remove Prior to Works

  • LCX Not Responsible for Loose Ornaments, Mirrors, Pictures etc. Customer must Remove Prior to Works

  • Customer Informed if Shower is NOT Compatible with ASHP

  • LCX Not Responsible for Shower

Customer Declaration

  • DECLARATION: I understand what what is due to be carried out and I agree to the positions of the pipe-work, radiators, cylinder, external unit and room thermostat.

  • I agree to the use of the welfare facilities in my property

  • Customer Signature

Sign Off

Assessment Sign off

  • Surveyors Signature and Full name

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.