LCX Combined Measure & DRA Survey F253 V2.6

Details

• Conducted on

  Date

• Prepared by

  Select Steve Britton Vince Stokes Sean Glossop Jez Illy Rob McKenna Alister Paisley David Fox Chris Spinks

  • Steve Britton
  • Vince Stokes
  • Sean Glossop
  • Jez Illy
  • Rob McKenna
  • Alister Paisley
  • David Fox
  • Chris Spinks

• Client and Tenure

  Select Exeter City Council Shal Housing Rooftop Alliance Homes East Devon Homes Abri Magna Celtic Horizons Selwood Live West Peabody Curo Owner Occupier Privately Rented Other

  • Exeter City Council
  • Shal Housing
  • Rooftop
  • Alliance Homes
  • East Devon Homes
  • Abri
  • Magna
  • Celtic Horizons
  • Selwood
  • Live West
  • Peabody
  • Curo
  • Owner Occupier
  • Privately Rented
  • Other

• Who?

• Survey Type

  Select LCX Combined Measure Survey & DRA F253

  • LCX Combined Measure Survey & DRA F253

• First Line of Address

• Front Elevation Photo

  Media

• What3Words Location

• GPS
  Address

Access Assessment

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

  Yes

  No

• Reasoning?

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

  Yes

  No

  N/A

• Photographic Evidence

  Media

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

  No

  Yes

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

  No

  Yes

• Comments

• Photographic evidence

  Media

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

  No

  Yes

• Comments

• Photographic evidence

  Media

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

  Yes

  No

• Comments,

• Photographic evidence

  Media

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

  Yes

  No

  Permit Zone

• Comments

• Photographic evidence

  Media

• Will the proposed works affect neighbouring properties ?

  No

  Yes

• Comments

• Photographic evidence

  Media

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

  Verbal Notification

  Information Letter Posted

  Not Required - Part of Scheme

  To Be Done By Site Manager

• Date of notification given-

  Date

Occupant Assessment

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

  Yes

  No

• Comments

• Photographic evidence

  Media

• Is the property highlighted as flagged or at risk ?

  No

  Yes

• Comments

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

  No

  Yes

• Comments

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

  No

  Yes

• Comments

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

  No

  Yes

• Comments

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

  No

  Yes

• Comments

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

  No

  Yes

• Comments

• Photographic evidence

  Media

• Is the property at high risk of hypodermic needles ?

  No

  Yes

• Comments

Asbestos Assessment

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

  Yes

  No

  Unknown

• Asbestos Assessment Needs to be Checked

• Comments

• Has asbestos been identified ?

  No

  Yes

  See Asbestos Report

  Possible

• Comments

• Photographic evidence

  Media

Customer Details

• Resident Name

• Resident Contact Number

• Resident Email

• Best Days for Installation / Days to Avoid

• Current Energy Supplier

  Select Utilita British Gas EON EDF Octopus OVO nPower Scottish Power Boost Other Unknown

  • Utilita
  • British Gas
  • EON
  • EDF
  • Octopus
  • OVO
  • nPower
  • Scottish Power
  • Boost
  • Other
  • Unknown

• Which Supplier?

• Is More Detailed Occupancy Information Required?

  Yes

  No

• Is the occupancy considered typical for the property?

  Yes

  No

  N/A

• Over or Under Occupied?

  Over Occupied

  Under Occupied

• How many people live in the property?

• Is there a thermostat?

  Yes

  No

  N/A

• Is the thermostat maintained at a typical temperature?

  Yes

  No

  N/A

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

  Lower

  Higher

  Neither

• Is the heating pattern considered typical for the property?

  Yes

  No

  N/A

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

  Lower

  Higher

  Neither

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Current Energy Efficiency Measures

  Select CWI 300mm+ Loft Insulation EWI Windows Renewed Heating Upgraded Thermostat Upgraded Other

  • CWI
  • 300mm+ Loft Insulation
  • EWI
  • Windows Renewed
  • Heating Upgraded
  • Thermostat Upgraded
  • Other

• What Other Measures?

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

  Yes

  No

  N/A

• Have you undertaken a separate occupancy assessment

  Yes

  No

• Which assessment version?

  Low Carbon Exchange Version

  Elmhurst Energy Version

  Other

• Specify

Basic Property Details

• Property Type

  House

  Bungalow

  Flat

  Maisonette

  Other

• What Type

• Attachment

  Select Semi Detached Linked Mid Terraced End Terraced Ground Floor Top Floor Mid Floor Other

  • Semi
  • Detached
  • Linked
  • Mid Terraced
  • End Terraced
  • Ground Floor
  • Top Floor
  • Mid Floor
  • Other

• What Type

• Building Finish

  Select Brick Painted Render Brick/Render Pebble Dash Concrete Block Recon Stone Spar UPVC Cladding Tile Hanging Limestone/Sandstone Granite/Whinstone Faced brick in a high exposure area not suitable for cavity wall insulation Other

  • Brick
  • Painted Render
  • Brick/Render
  • Pebble Dash
  • Concrete Block
  • Recon Stone
  • Spar
  • UPVC Cladding
  • Tile Hanging
  • Limestone/Sandstone
  • Granite/Whinstone
  • Faced brick in a high exposure area not suitable for cavity wall insulation
  • Other

• What Type

• Construction Type

  Select Cavity Wall Solid Brick System Built Metal Frame Other

  • Cavity Wall
  • Solid Brick
  • System Built
  • Metal Frame
  • Other

• Structural Condition of Wall

  Good

  Fair

  Poor

  N/A

• Structural Issues/Remedial Works Required

  Yes

  No

  N/A

• Details of remedial works and photos

• Photo of remedial works required

  Media

• Age Band

  Select A - Pre 1900 B - 1900 - 1929 C - 1930 - 1949 D - 1950 - 1966 E - 1967 - 1975 F - 1976 - 1982 G - 1983 - 1990 H - 1991 - 1995 I - 1996 - 2002 J -2003 - 2006 K - 2007 - 2011 L - 2012 onwards

  • A - Pre 1900
  • B - 1900 - 1929
  • C - 1930 - 1949
  • D - 1950 - 1966
  • E - 1967 - 1975
  • F - 1976 - 1982
  • G - 1983 - 1990
  • H - 1991 - 1995
  • I - 1996 - 2002
  • J -2003 - 2006
  • K - 2007 - 2011
  • L - 2012 onwards

• Listed Building / Conservation Area

  Yes

  No

  N/A

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

  Yes

  No

• Should the planning department be notified?

  Yes

  No

  N/A

• Number of Storeys

  Select 0 1 2 3 4 5 6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Floor Construction Type

  Select Solid Suspended Timber Suspended, Not Timber Unknown

  • Solid
  • Suspended Timber
  • Suspended, Not Timber
  • Unknown

• Structural Condition of Floor

  Good

  Fair

  Poor

  N/A

• Structural Condition of Roof

  Good

  Fair

  Poor

  N/A

• Internal Inspection of Building Completed

  Yes

  No

• What Condition is the Inside

  Select No Internal Issues Visible Damage to Ceiling Water Stain on Ceiling Low Level Damp Near Skirting Boards Black Mould in the Corners of the Rooms Black Mould on the Ceiling and Walls Condensation on the Windows and External Walls Other

  • No Internal Issues Visible
  • Damage to Ceiling
  • Water Stain on Ceiling
  • Low Level Damp Near Skirting Boards
  • Black Mould in the Corners of the Rooms
  • Black Mould on the Ceiling and Walls
  • Condensation on the Windows and External Walls
  • Other

• Photographic Evidence

  Media

• What Rooms?

  Select Lounge Kitchen Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bathroom W/C Other

  • Lounge
  • Kitchen
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bathroom
  • W/C
  • Other

• Number of Bedrooms

  Select 0 1 2 3 4 5 6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Number of Bathrooms

  Select 0 1 2 3 4 5 6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Main Heating Type?

  Select Mains Gas Oil Solid Fuel Electric Heat Pump LPG Heating not working at the time of survey Other

  • Mains Gas
  • Oil
  • Solid Fuel
  • Electric
  • Heat Pump
  • LPG
  • Heating not working at the time of survey
  • Other

• Boiler Type

  Vaillant

  Other

• Type?

• Boiler Model

  EcoTec Pro 24

  Other

• What Model?

• Boiler Location

  Kitchen

  Hallway

  Out Building

  Dining Room

  Other

• What Location?

• Heating Controls Type

• Heating Controls Location

  Hallway

  Lounge

  Kitchen

  Other

• Where

• New Heating Control Proposed Location

  Manufacturers Recommended

  Other

• Where?

• Photographic Evidence

  Media

• What Type

• What Type

  Select Old Storage Heaters High Heat Retention (Quantums) Panel Heaters Portable Heaters Other

  • Old Storage Heaters
  • High Heat Retention (Quantums)
  • Panel Heaters
  • Portable Heaters
  • Other

• Heat Pump Type

  Air Source Heat Pump

  Ground Source Heat Pump

  Water Source Heat Pump

  Other

• Secondary Heat source?

  Select No other heating present Electric Effect Fire Gas Fire with Flue Gas Fire with chimney Gas Fire Flush Fitted Open Fire with internal chimney Open Fire with external chimney Wood Burner Other

  • No other heating present
  • Electric Effect Fire
  • Gas Fire with Flue
  • Gas Fire with chimney
  • Gas Fire Flush Fitted
  • Open Fire with internal chimney
  • Open Fire with external chimney
  • Wood Burner
  • Other

• Photographic Evidence

  Media

• Safety Monitors Present

  Select Smoke Detector Carbon Monoxide Detector Heat Detector

  • Smoke Detector
  • Carbon Monoxide Detector
  • Heat Detector

• Photographic Evidence

  Media

• 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

  Yes

  No

  N/A

• Give Details

• On Site Parking

  On Street Close By

  On Street Short Distance

  Driveway

  Other

• Where?

• Any Access Issues

  Yes

  No

• What Issues are Present

Loft Insulation Survey

• Is Loft Insulation a Proposed Measure?

  Yes

  No

• Is the Loft Accessible?

  Yes

  No

  N/A

• Is loft to be insulated.

  Select Yes loft requires topping up No Loft has sufficient insulation Unable to check due to the amount of tenants belongings.

  • Yes loft requires topping up
  • No Loft has sufficient insulation
  • Unable to check due to the amount of tenants belongings.

• Photo of loft and access point

  Media

• Loft Hatch Size?

• Area to be insulated.

• Existing Depth.

  Select 0mm 12mm 25mm 50mm 70mm 80mm 100mm 125mm 150mm 170mm 200mm 250mm 270mm 300mm plus

  • 0mm
  • 12mm
  • 25mm
  • 50mm
  • 70mm
  • 80mm
  • 100mm
  • 125mm
  • 150mm
  • 170mm
  • 200mm
  • 250mm
  • 270mm
  • 300mm plus

• Photo of existing depth.

  Media

• Minimum Depth to be achieved

  Select 270mm 300mm 350mm 400mm

  • 270mm
  • 300mm
  • 350mm
  • 400mm

• Pipes and Tanks Present

  Yes

  No

  N/A

• Details and size of tanks to be insulated

• Number and length of pipes to be lagged

• Check on site

• Down lights present in ceiling?

  Yes

  No

  N/A

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

• Do they have halogen bulbs fitted.

  Yes

  No

  N/A

• Can you see the IP rating on the casing?

  Yes

  No

  N/A

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

  Media

• Are there any existing down light covers fitted?

  Yes

  No

  N/A

• If YES are they fire rated covers?

  Yes

  No

  N/A

• Electrical wiring free from visual defects?

  Yes

  No

  N/A

• Any evidence of electric wiring trapped between insulation?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Select Cooker cable Shower cable Immersion cable PV cable

  • Cooker cable
  • Shower cable
  • Immersion cable
  • PV cable

• In your opinion should loft be Rolled or Blown?

  Rolled

  Blown

• Loft Height at Centre

  Select 0.80 metres 0.90 metres 1.00 metres 1.20 metres 1.40 metres 1.50 metres 1.60 metres 1.80 metres and above.

  • 0.80 metres
  • 0.90 metres
  • 1.00 metres
  • 1.20 metres
  • 1.40 metres
  • 1.50 metres
  • 1.60 metres
  • 1.80 metres and above.

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

  Yes

  No

  N/A

• Relay of Insulation Required?

  Yes

  No

  N/A

• Estimate of relaying time allocation

• Loft hatch needing D/P

  Yes

  No

  N/A

• Does the hatch need to be replaced?

  Yes

  No

  N/A

• Loft vents required

  Yes

  No

  Unknown

• Areas to be omitted

  Yes

  No

  N/A

• What Areas?

• Does the loft have any boarding?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has the boarded area got insulation under it?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is roof eaves insulation present

  Yes

  No

  N/A

• Can the insulation be undertaken through the loft space

  Yes

  No

  N/A

• How should it be installed?

• Rafter depth (mm)

• What is the roof covering?

  Select Clay Concrete Slate Interlocking Lapped Unknown

  • Clay
  • Concrete
  • Slate
  • Interlocking
  • Lapped
  • Unknown

• Breathable felt fitted?

  Yes

  No

  Eaves Only

• Is the specification available?

  Yes

  No

  Unknown

• Walkway required

  Yes

  No

  N/A

• Details of walkway

  Select Required to access all areas Access to heat pump equipment Access to inverter Access to hot water cylinder Other

  • Required to access all areas
  • Access to heat pump equipment
  • Access to inverter
  • Access to hot water cylinder
  • Other

• What is Required?

• Loft clearance

  Yes

  No

  N/A

• Details of loft clearance

• Estimate of loft clearance time allocation

• Why?

  Select No Hatch Hatch Blocked Hatch Over Stairs (Cannot Access Safely) Resident Refused Access Other

  • No Hatch
  • Hatch Blocked
  • Hatch Over Stairs (Cannot Access Safely)
  • Resident Refused Access
  • Other

• What?

Cavity Wall Survey

• Is Cavity Wall Insulation a Proposed Measure?

  Yes

  No

• Required material.

  Thermabead White 15/5181

  Thermabead Carbon 15/5181

  TBC

  Other

• What type?

• Total area to be insulated.

• Any Omitted Areas

  Yes

  No

  N/A

• Total area to be omitted.

• Photos of omitted areas.

  Media

• Material to be Extracted

  Select Yellow/White Fibre Foam Rockwool Loose Polystyrene Bead Debris / Rubble Over Bonded Bead

  • Yellow/White Fibre
  • Foam
  • Rockwool
  • Loose Polystyrene Bead
  • Debris / Rubble
  • Over Bonded Bead

• Average Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

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

  Media

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

  Select Bedroom ventilation Combustion ventilation Bathroom ventilation or extraction fan Kitchen ventilation or extraction fan Pantry vents Underfloor vents Trickle vents None

  • Bedroom ventilation
  • Combustion ventilation
  • Bathroom ventilation or extraction fan
  • Kitchen ventilation or extraction fan
  • Pantry vents
  • Underfloor vents
  • Trickle vents
  • None

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

  Media

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

  Yes

  No

  N/A

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

  Select Bedroom ventilation Combustion ventilation Bathroom ventilation or extraction fan Kitchen ventilation or extraction fan Pantry vents Underfloor vents Trickle vents None

  • Bedroom ventilation
  • Combustion ventilation
  • Bathroom ventilation or extraction fan
  • Kitchen ventilation or extraction fan
  • Pantry vents
  • Underfloor vents
  • Trickle vents
  • None

• Installer to check

• Adjoining properties insulated ?

  Yes

  No

  N/A

• Is it included in this project?

  Yes

  No

  N/A

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

• Location of Flue

  Select Front Rear Left from front Right from front Garage and/or outbuilding Centre of roof (cavity unaffected) Other elevations N/A

  • Front
  • Rear
  • Left from front
  • Right from front
  • Garage and/or outbuilding
  • Centre of roof (cavity unaffected)
  • Other elevations
  • N/A

• Combustion core vent required.

  Yes

  No

  N/A

• Number of combustion vents required.

• Why?

  No Fireplace

  Fireplace permanently sealed

  Other

Front Elevation.

• Cavity Depth.

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Photos of tape measure in the cavity.

  Media

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

  Media

• Borescope Photos

  Media

• Photo of DPC showing a tape measure

  Media

• Is a French Drain Required?

  Yes

  No

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

  Yes

  No

• Comments

Rear Elevation

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Photos of tape measure in the cavity.

  Media

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

  Media

• Borescope Photos

  Media

• Photo of DPC showing a tape measure

  Media

• Is a French Drain Required?

  Yes

  No

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

  Yes

  No

• Comments

Right hand elevation

• Is there a right hand elevation on this property

  Yes

  No

  N/A

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Photos of tape measure in the cavity.

  Media

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

  Media

• Borescope Photos

  Media

• Photo of DPC showing a tape measure

  Media

• Is a French Drain Required?

  Yes

  No

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

  Yes

  No

• Comments

Left hand elevation

• Is there a left hand elevation on this property

  Yes

  No

  N/A

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

• Photos of tape measure in the cavity.

  Media

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

  Media

• Borescope Photos

  Media

• Photo of DPC showing a tape measure

  Media

• Is a French Drain Required?

  Yes

  No

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

  Yes

  No

• Comments

Building extensions

• Is there an extension on this property

  Yes

  No

  N/A

• Cavity Depth

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm 115mm 120mm 125mm 130mm 135mm 140mm 145mm 150mm 155mm 160mm 165mm 170mm 175mm 180mm 185mm 190mm 195mm 200mm

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 105mm
  • 110mm
  • 115mm
  • 120mm
  • 125mm
  • 130mm
  • 135mm
  • 140mm
  • 145mm
  • 150mm
  • 155mm
  • 160mm
  • 165mm
  • 170mm
  • 175mm
  • 180mm
  • 185mm
  • 190mm
  • 195mm
  • 200mm

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

  Media

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

  Media

• Borescope Photos

  Media

• Photo of DPC showing a tape measure

  Media

• Is a French Drain Required?

  Yes

  No

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

  Yes

  No

• Comments

Funding Questions

• Is Funding Available?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Do all wet rooms have closing doors?

  Yes

  No

  N/A

• Is there a passive ventilation system?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are there more bedrooms than occupants?

  Yes

  No

  N/A

• Is there single glazing at the property?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

External Wall Insulation Survey

• Is an external wall insulation survey required?

  EWI Survey

• Number of elevations to be treated

  Select 0 1 2 3 4 5 6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Does the wall have cavity insulation?

  YES

  NO

  N/A

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

  YES

  NO

  NA

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

  YES

  NO

  NA

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

  NO

  YES

EEM DESIGN:

• Design accounts for building exposure:

  NO

  YES

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

  NO

  YES

• Comments

• Design eliminates thermal bridging:

  NO

  YES

• Design minimises thermal bridging

  YES

  NO

  NA

Existing Finishes: External/Internal

• Agrees with Retro fit Assessment and Design

  NO

  YES

• External Finishes

  Select Stone Brick Sand & Cement Render Mass Concrete Dry dash Wet Dash Concrete Block Wood paint Tile Hanging Other

  • Stone
  • Brick
  • Sand & Cement Render
  • Mass Concrete
  • Dry dash
  • Wet Dash
  • Concrete Block
  • Wood paint
  • Tile Hanging
  • Other

• Please state other type of finish.

• Internal: Colours & Textures

  Select Plaster skim Plaster board Sand and Cement Insulated Plaster Board Timber Other

  • Plaster skim
  • Plaster board
  • Sand and Cement
  • Insulated Plaster Board
  • Timber
  • Other

• Other internal finishes please specify:

  Select Wallpaper Paint Tiles

  • Wallpaper
  • Paint
  • Tiles

• Comments:

Through Wall Construction

• Internal to external surface layers

• Overall Wall Thickness

• Photo of wall thickness

  Media

• Layer 1

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 2

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 3

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 4

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 5

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 6

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 7

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Has a second through wall construction been identified ?

  YES

  NO

  N/A

• Overall Wall Thickness

• Photo of wall thickness

  Media

• Layer 1

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 2

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 3

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 4

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 5

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 6

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 7

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Has a third through wall construction been identified ?

  YES

  NO

  N/A

• Overall Wall Thickness

• Photo of wall thickness

  Media

• Layer 1

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 2

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 3

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 4

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 5

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 6

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

• Layer 7

  Select Wallpaper Paint Plaster Skim Render Dense Concrete Block Lightweight Concrete Block Cavity Cavity Insulation Timber Frame Plywood Plasterboard Insulated Plasterboard Dry Dash Wet Dash Hanging Tile Brickwork Stone System built Concrete wall with cavity System built Concrete without cavity Metal Frame

  • Wallpaper
  • Paint
  • Plaster Skim
  • Render
  • Dense Concrete Block
  • Lightweight Concrete Block
  • Cavity
  • Cavity Insulation
  • Timber Frame
  • Plywood
  • Plasterboard
  • Insulated Plasterboard
  • Dry Dash
  • Wet Dash
  • Hanging Tile
  • Brickwork
  • Stone
  • System built Concrete wall with cavity
  • System built Concrete without cavity
  • Metal Frame

Property Elevation Photos

• Which Elevations exist on this property

  Select Front Rear Left from front Right from front Garage and/or outbuilding Centre of roof (cavity unaffected) Other elevations N/A

  • Front
  • Rear
  • Left from front
  • Right from front
  • Garage and/or outbuilding
  • Centre of roof (cavity unaffected)
  • Other elevations
  • N/A

• Photos

  Media

Property Measurements:

• Property Sketch Photos with Measures

  Media

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 ?

  Yes

  No

• What are the Details?

• Requires Competent Person e.g. Structural Engineer

  Yes

  No

  N/A

• Photos of Structural Defects

  Media

• EEM Design:

• Structural repairs included in the design before works start

  NO

  YES

  N/A

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

  NO

  YES

  N/A

• Site pull-out tests undertaken for mechanical fixings

  NO

  YES

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

  NO

  YES

• Design eliminates thermal bridging

  NO

  YES

• Design minimises thermal bridging

  NO

  YES

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

  NO

  YES

EXISTING RENDER:

• Comments:

  Select No evidence of defects Defects apparent

  • No evidence of defects
  • Defects apparent

• Comments on apparent defects

• Agrees with Retrofit Assessment/Design

  NO

  YES

• Photo(s)

  Media

• EEM Design:

• Requires removal, partial removal, repair

  YES

  NO

  N/A

• Render repair included in the design

  NO

  YES

  N/A

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

  NO

  YES

  N/A

PRESENCE OF DAMP (RISING, PENETRATING OR CONDENSATION):

• Comments

  No Evidence of Damp

  Evidence of Damp

• Comments on damp

• Photo(s)

  Media

• EEM Design:

• Damp treatment included in the design

  NO

  YES

  N/A

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

  NO

  YES

  N/A

FROST DAMAGE:

• Comments

  Select No evidence of weathering damage Evidence of weathering damage

  • No evidence of weathering damage
  • Evidence of weathering damage

• Photo(s)

  Media

• EEM Design:

• Frost repair included in the design

  NO

  YES

  N/A

• Frost repair measure to be carried out before

  NO

  YES

  N/A

DETAIL/LOCATION OF MOVEMENT JOINTS:

• Are there Movement Joints

  Select No movement joints in existing or required by EEM Movement joints in existing New movement joints required

  • No movement joints in existing or required by EEM
  • Movement joints in existing
  • New movement joints required

• Comments of movement joints

• Photo(s)

  Media

• EEM Design:

• Included in the design

  NO

  YES

  N/A

• Design eliminates Thermal bridging

  NO

  YES

• Design minimises Thermal bridging

  NO

  YES

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

  NO

  YES

MOSS/LICHEN/MOULD/IVY or EFFLORESCENCE

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

  No evidence of Growth

  Evidence of Growth

• Comments of growth

• Photo(s)

  Media

• EEM Design:

• Remediation included in the design

  NO

  YES

  N/A

• Design eliminates cold bridging

  NO

  YES

• Design minimises cold bridging

  NO

  YES

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

  NO

  YES

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

• Photo(s):

  Media

• Window material type

  Select UPVC Timber Metal Composite

  • UPVC
  • Timber
  • Metal
  • Composite

• Window Renewal

  NO

  YES

• Door material type

  Select UPVC Timber Metal Composite

  • UPVC
  • Timber
  • Metal
  • Composite

• External Door Renewal

  NO

  YES

• EEM Design:

• Design eliminates Thermal bridging

  NO

  YES

• Design minimises Thermal bridging

  NO

  YES

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

  NO

  YES

• Comments:

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

• Photo(s)

  Media

• EEM Design:

• Design eliminates Thermal bridging

  NO

  YES

• Design minimises Thermal bridging

  NO

  YES

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

  NO

  YES

• Comments:

EXTERNAL ELECTRICAL CABLES/EQUIPMENT:

• Photo(s)

  Media

• EEM Design:

• Design eliminates Thermal bridging

  NO

  YES

• Design minimises Thermal bridging

  NO

  YES

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

  NO

  YES

• Comments:

EWI ABUTMENT TO EAVES & ROOFS:

• Photo(s)

  Media

• EEM Design:

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

  NO

  YES

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

  NO

  YES

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

  NO

  YES

• Comments:

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

• Photo(s)

  Media

• EEM Design:

• Design eliminates Thermal bridging

  NO

  YES

• Design minimises Thermal bridging

  NO

  YES

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

  NO

  YES

• Comments:

RAIN WATER AND DRAINAGE PIPES:

• Photo(s):

  Media

• EEM Design:

• Can existing Pipework be moved ?

  NO

  YES

• Design eliminates Thermal bridging

  NO

  YES

• Design minimises Thermal bridging

  NO

  YES

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

  NO

  YES

• Comments:

DAMP PROOF COURSE(DPC) PROVISION AND LOCATION:

• Photo(s) of DPC (Each Elevation)

  Media

• EEM Design:

• Design eliminates Thermal bridging

  Yes

  No

  N/A

• Design minimises Thermal bridging

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Comments (including any insulated plinth detail and location)

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

• Photo(s)

  Media

• EEM Design:

• Design eliminates Thermal bridging

  NO

  YES

• Design minimises Thermal bridging

  NO

  YES

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

  NO

  YES

• Comments:

Ventilation Survey

• Is a Ventilation Survey Required?

  Yes

  No

• Living Room?

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Dining Room?

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Bedroom 1?

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Bedroom 2?

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Bedroom 3?

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Bedroom 4?

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Bedroom 5?

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Study?

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Other Specify?

  Yes

  No

  N/A

• What Room

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Kitchen?

  Yes

  No

  N/A

• Has Extractor Fan

  Yes

  No

  N/A

• Is it an in Wall or Window Extractor Fan

  In Wall

  Window

• Is the Extractor Fan Working

  Yes

  No

• Extractor Fan Flow Rate

• Requirements

• Does it Meet the Requirements

  Yes

  No

• Does it Require Replacement?

  Yes

  No

• Does it Require Replacement

  Yes

  No

  N/A

• New Extractor to be Installed in Kitchen

• New Extractor to be Fitted in Wall or Window

  In Wall

  Window

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• Bathroom?

  Yes

  No

  N/A

• Has Extractor Fan

  Yes

  No

  N/A

• Is it an in Wall or Window Extractor Fan

  In Wall

  Window

• Is the Extractor Fan Working

  Yes

  No

• Extractor Fan Flow Rate

• Requirements

• Does it Meet the Requirements

  Yes

  No

• Does it Require Replacement?

  Yes

  No

• Does it Require Replacement

  Yes

  No

  N/A

• New Extractor to be Installed in Bathroom

• New Extractor to be Fitted in Wall or Window

  In Wall

  Window

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• W/C?

  Yes

  No

  N/A

• Has Extractor Fan

  Yes

  No

  N/A

• Is it an in Wall or Window Extractor Fan

  In Wall

  Window

• Is the Extractor Fan Working

  Yes

  No

• Extractor Fan Flow Rate

• Requirements

• Does it Meet the Requirements

  Yes

  No

• Does it Require Replacement?

  Yes

  No

• Does it Require Replacement

  Yes

  No

  N/A

• Has Required Door Undercuts

  Yes

  No

  No Door

  N/A

• Door Requires Trimming

  Yes

  No

  N/A

• Has Purge Ventilation

  Yes

  No

  N/A

• Has Trickle Vents / Background Ventilation

  Yes

  No

  N/A

• Photos

  Media

• New Extractor to be Fitted in Wall or Window

  In Wall

  Window

PV Survey

• Is a PV Survey Required

  Yes

  No

Roof Type

• Roof Style

  Select Gable Roof Hipped Roof Gambrel Roof (barn style) Flat Roof Mansard Roof Shed Roof

  • Gable Roof
  • Hipped Roof
  • Gambrel Roof (barn style)
  • Flat Roof
  • Mansard Roof
  • Shed Roof

• Tile Type

  Select Plain tiles / Slates (solar limpets) Low profile Interlocking tiles / Redland Tiles (220 wide) Profiled Tiles (Standard) Flat Roof

  • Plain tiles / Slates (solar limpets)
  • Low profile Interlocking tiles / Redland Tiles (220 wide)
  • Profiled Tiles (Standard)
  • Flat Roof

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

  Select Clay Concrete Slate Interlocking Lapped Unknown

  • Clay
  • Concrete
  • Slate
  • Interlocking
  • Lapped
  • Unknown

Roofing and Scaffold

• Scaffold Location

  Select Front Back Left Side Right Side

  • Front
  • Back
  • Left Side
  • Right Side

• Height of Eaves? (Metres)

• Required Access to rear?

  Yes

  No

• Location of rear access

  Side Gate

  Side Access

  Back Gate

  Other

• 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?

  Yes

  No

  N/A

• Roof type

  Trussed Roof

  Cut Roof

  Other

• Size of Purlin (mm)

• Number of Purlin Supports Front

  Select 0 1 2 3 4 5 6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Number of Purlin Supports Back

  Select 0 1 2 3 4 5 6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Number of Purlin Supports Side

  Select 0 1 2 3 4 5 6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Maximum Unsupported Rafter Length (Metres)

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

• Number of Trusses/Rafters

• Rafter/Truss Centres (mm)

• Timber Condtion

  Good

  Fair

  Poor

  N/A

• Felt Condition

  Good

  Fair

  Poor

  N/A

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

• Loft Condition

  Select Clear Cluttered Tenant Agreed to clear loft Area Around Hatch Blocking Access

  • Clear
  • Cluttered
  • Tenant Agreed to clear loft
  • Area Around Hatch Blocking Access

• Is There a Smoke Detector in the Loft

  Yes

  No

• New Smoke Detector to be Fitted in Loft

• What is the Make and Model

• Does it Need Replacing With Client Specified Model

  Yes

  No

  N/A

• Any Issues With Loft access

  None

  Yes

• What Issues?

• Loft Headroom Meters

  Select 0.80 metres 0.90 metres 1.00 metres 1.20 metres 1.40 metres 1.50 metres 1.60 metres 1.80 metres and above.

  • 0.80 metres
  • 0.90 metres
  • 1.00 metres
  • 1.20 metres
  • 1.40 metres
  • 1.50 metres
  • 1.60 metres
  • 1.80 metres and above.

• Temporary Loft Light Required

  Yes

  No

• Temporary Loft Walkway Required

  Yes

  No

• Why?

  Select No Hatch Hatch Blocked Hatch Over Stairs (Cannot Access Safely) Resident Refused Access Other

  • No Hatch
  • Hatch Blocked
  • Hatch Over Stairs (Cannot Access Safely)
  • Resident Refused Access
  • Other

• Notes

Electrics

• Consumer Unit Make and Model

  Select Crabtree Starbreaker Hager MK Lewden Wylex Schneider Other Unable to Access

  • Crabtree Starbreaker
  • Hager
  • MK
  • Lewden
  • Wylex
  • Schneider
  • Other
  • Unable to Access

• What Brand?

• Breaker Type

  Type A

  Type B

• Location

  Select Under Stairs Front Hallway Cupboard External Other Under Sink Unknown

  • Under Stairs
  • Front Hallway
  • Cupboard
  • External
  • Other
  • Under Sink
  • Unknown

• Where?

• Distribution Board Upgrade Required

  Yes

  No

  N/A

• Spare Way for PV

  Yes

  No

• Additional Garage DB Required for PV

  Yes

  No

  N/A

• Earthing to Gas Meter

  Yes

  No

  No Gas

• Gas Meter Location

  Select Under Stairs Front Hallway Cupboard External Other Under Sink Unknown

  • Under Stairs
  • Front Hallway
  • Cupboard
  • External
  • Other
  • Under Sink
  • Unknown

• Where?

• Earthing to Water Main

  Yes

  No

  Unknown

• Water Main Location

  Select Under Stairs Front Hallway Cupboard External Other Under Sink Unknown

  • Under Stairs
  • Front Hallway
  • Cupboard
  • External
  • Other
  • Under Sink
  • Unknown

• Where?

• Earthing Type

  TN-C-S (PME)

  TN-S

  TT

Import Meter Type

• Meter Type

  Electronic Credit Meter

  Key Budget Meter

  Dial Credit Meter

  Smart Meter

• Does Meter require changing?

  Yes

  No

  N/A

• Make and Model of Meter

  Secure Liberty 100

  Landis GYR E470

  Aclara SGM1412-B

  Other

• What Model?

• Meter Serial Number

• Is the MPAN Number Present

  Yes

  No

• What is the MPAN Number

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

  Already Has Isolation

  Yes

  No

• Import Meter Location

  Next to DB

  External

  Other

• Where is it?

• Generation Meter Location (Proposed)

  Next to DB

  Other

• Where shoud it be located?

Photovoltaic System Proposed

• Proposed Inverter Location

  Loft

  Next to DB

  External

  Other

• Where should is be located?

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

  Yes

  No

• Approx AC cable run length from Consumer Unit to Inverter

  5m

  10m

  15m

  20m

• Cellular Networks Checked with Good Signal?

  Select O2 Vodaphone BT EE 3 Other

  • O2
  • Vodaphone
  • BT EE
  • 3
  • Other

• Will there be Battery Storage

  Yes

  No

• Size of Proposed Area

• Distance to DB

  5m

  10m

  15m

  20m

• Proposed Battery Location

• Photo of Proposed Location

  Media

Photo Checklist

• Property Elevations, Front Door & Scaffold Access

  Media

• Suitable Roof Elevation Close Up including gutter

  Media

• Proposed Inverter Location

  Media

• Roof Void if relevant including TV ariel

  Media

• Consumer Unit and Close up of Breakers

  Media

• Electricity Meter & Mains Fuse / Earth in Meter Box

  Media

• Water main bond

  Media

• Gas Main bond (if applicable)

  Media

• Satellite dish (if any) including closeup of bracket

  Media

Shading

• Has SunEye Survey been completed

  Yes

  No

• Why?

  Unable to Access

  Weather (Raining, Windy etc)

  Other

• Notes

• Notes

• Is an Air Source Heat Pump Survey Required

  Yes

  No

• Water Pressure

  Good

  Fair

  Poor

  N/A

• BBU Removal Required

  Yes

  No

• Photographic Evidence

  Media

• Fireplace Removal/Block up Required

  Yes

  No

• Photographic Evidence

  Media

• Window Material Type

  UPVC

  Timber

  Metal

  Composite

• Loft Water Tank Removal

  Yes

  No

• Electricity Cost per kWh

• Fuse Board and Main Fuse Cut Out Rating

  Media

• Main Fuse Cut Out Rating

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

  Yes

  No

• Photographic Evidence

  Media

• Smart Meter Installed?

  Yes

  No

• Electric Meter Photographic Evidence

  Media

Cylinder Cupboard

• Door Size

• Cupboard Depth, Width & Height

• Photographic Evidence of Cylinder Cupboard

  Media

• What Size of Cylinder Will Fit

  Slimline 475

  Slim 550

  No Max

  Unknown

• How will the Dischage Pipe Route to Outside be done

• Existing Cylinder Type

Proposed Heat Pump

• Bracket Type

  Ground

  Wall

• Proposed Location

• Proposed Location Photo

  Media

• ASHP Soak Away Required

  Yes

  No

  N/A

• Recommendation

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

• Trunking Requirements

• Can the External Unit be Installed 1m from Boundary

  Yes

  No

• Recommended Solution

• How Many Reflective Surfaces

  1

  2

  3

• Distance to Nearest Habitable Room

• From Assessment Area What Barrier is in Place

  None

  Part

  Full

Thermostat

• Current Thermostat Position

• Photo of Current Location

  Media

• Proposed Thermostat Position

  Same

  Different

• Photo of Proposed Location

  Media

Existing Heating

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

• Storage Heater Serial Number (For Asbestos Purposes)

Room Details

• Floor Construction Type

  Solid

  Suspended Timber

  Suspended, Not Timber

  Unknown

• Floorplan Showing Individual Room Sizes and Ceiling Height

  Media

• Living Room

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Hallway

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Dining Room

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Upper Floor Hallway/Landing

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Bedroom 1

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Bedroom 2

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Bedroom 3

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Bedroom 4

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Bedroom 5

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Study

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Kitchen

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Bathroom

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• W/C

  Yes

  No

  N/A

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• Other Specify

  Yes

  No

  N/A

• What Room

• Window Sizes

• Number of Outside Walls

• Internal Wall Type

  Wallpapered

  Painted

  Plastered

  Exposed

• Max Space Available for Radiator (Length, Height)

• Existing Radiator Size

• Photo

  Media

• 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

Assessment Sign off

• Surveyors Signature and Full name

  Sign