Loft Insulation Survey v2.3

• Record Loft insulation, cold bridge. Additional work ?

  Yes

  No

• Select activities

  Select High voltage cable / cables Loft Top Up Resident item move Patch and eave relay - additional Lagging Hatch Tanks Felt Cuts NCA only Door Undercuts Cold Bridge Other

  • High voltage cable / cables
  • Loft Top Up
  • Resident item move
  • Patch and eave relay - additional
  • Lagging
  • Hatch
  • Tanks
  • Felt Cuts NCA only
  • Door Undercuts
  • Cold Bridge
  • Other

undefined

• Yes

  No

• Add all media photos - include loft depth

  Yes

  No

• Any major issues to highlight ?

  Yes

  No

• DETAIL MAJOR ISSUE OR ACTION REQUIRED

  Yes

  No

• Location Including Postcode
  Address

• First line of the Address.

• Survey conducted by.

• Are we the lead installer responsible for PAS and funding claim?

  Yes

  No

  N/A

• Customer Name:

• Tenure.

  Select Owner occupier Local Authority Housing Association Privately Rented

  • Owner occupier
  • Local Authority
  • Housing Association
  • Privately Rented

• Contact Details and Type

• House Type.

  Select

• Property Type

  Select

• Number of Bedrooms.

• Construction age of the property.

• Main Heating type : Take photos of the appliance and the rating plate or appliance ID.

  Mains Gas/LPG

  Oil

  Solid Fuel

  Electric

  Renewable Technology/Other

• Location of the flue.

  Select Internal External Front Elevation Rear Elevation Left Hand Elevation Right Hand Elevation Does the flue pass thought the loft space None

  • Internal
  • External
  • Front Elevation
  • Rear Elevation
  • Left Hand Elevation
  • Right Hand Elevation
  • Does the flue pass thought the loft space
  • None

• Secondary heating.

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

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

• If secondary heating present please take a photo.

  Yes

  No

  N/A

• Structural Condition of the roof.

  Select Very good Good Poor Very poor

  • Very good
  • Good
  • Poor
  • Very poor

• External Condition of the building.

  Select Very good Good Poor Very poor

  • Very good
  • Good
  • Poor
  • Very poor

• Remedial Works Required (Property fabric) (not amend current)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If yes please give details of remedial work required plus photos.

• Have you done an internal inspection of the building.

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If you have answered yes please select the best description of your findings.

  Select Damage to ceiling Water stain on ceiling Low level damp near the skirting boards Black mould in the corners of the rooms Black mould on the ceiling and the walls Condensation on the windows and external walls No internal issues that I can see.

  • Damage to ceiling
  • Water stain on ceiling
  • Low level damp near the skirting boards
  • Black mould in the corners of the rooms
  • Black mould on the ceiling and the walls
  • Condensation on the windows and external walls
  • No internal issues that I can see.

• Please take photos of your internal findings.

  Media

• Safety monitors present.

  Select Smoke Alarm Fire Alarm CO2 Alarm

  • Smoke Alarm
  • Fire Alarm
  • CO2 Alarm

• Have the alarms all been tested by surveyor.

• Protected species, non domestic birds or rodents present in building ?

  Yes

  No

• Special Instructions.

Access

• On site parking notes : Availability, Restrictions

• Client Instructions.

• Access Issues (parking to dwelling)

• Installer Access Equipment Required (non standard) (not tele ladder/stand up box)

  Select None Ladders Stairs platform system Scaffold Board for Flat Roof Scaffolding Conservatory Ladder Roof Ladder Scaffold Tower (internal or external)

  • None
  • Ladders
  • Stairs platform system
  • Scaffold Board for Flat Roof
  • Scaffolding
  • Conservatory Ladder
  • Roof Ladder
  • Scaffold Tower (internal or external)

Loft Insulation.

• 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.

• Photos of all loft hatches and access point(s)

  Media

• Hatch material and insulation plan?

  Select Wooden - Fibreglass Wooden - Insulation board 50mm - silicone Metal - Insulation board 50mm - silicone

  • Wooden - Fibreglass
  • Wooden - Insulation board 50mm - silicone
  • Metal - Insulation board 50mm - silicone

• Is a loft hatch present and accessible?

  Yes

  No

  N/A

• Is the hatch suitable to prevent moisture and able to be draughtproofed?

  Yes

  No

  N/A

• Details of hatch required (hatch only or hatch and surround)?

• Loft Hatch Size required?

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

  Yes

  No

• Loft hatch needing D/P

  Yes

  No

  N/A

• Electrical wiring free from visual defects?

  Yes

  No

• Are there any high voltage cables in the loft space?

  Yes

  No

• If YES please select the type of cable.

  Cooker cable

  Shower cable

  Immersion cable

  PV cable

• 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.

• 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

• Depth to be added.

  Select Existing over 270mm - add zero 100mm 150mm 170mm 200mm 250mm 270mm 300mm 350mm 400mm 450mm

  • Existing over 270mm - add zero
  • 100mm
  • 150mm
  • 170mm
  • 200mm
  • 250mm
  • 270mm
  • 300mm
  • 350mm
  • 400mm
  • 450mm

• In your opinion should loft insulation be Rolled or Blown?

  Rolled

  Blown

• Pipes and Tanks Present requiring lagging?

  Yes

  No

• Details of Pipes and Tanks to be insulated

• Down lights present in ceiling?

  Yes

  No

• Details of down lights, location/rooms

• Are any existing down light covers fitted?

  Yes

  No

• If YES are these down light covers fire rated to the correct standard?

  Yes

  No

• Are there 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

• Loft Survey Image - Plan

  Media

• Relay Required - amended to ensure no patches (bare plaster) and meets cold bridge?

  Yes

  No

• Describe work required, location and instruction.

• Area of amendment required? (Consider labour, time to amend existing insulation material.)

• Additional notes for relay work

• Area of additional fibreglass required? (no additional charge if topping up)

• Loft vents required ?

  Yes

  No

• Areas to be omitted ?

  Yes

  No

• Does the loft have any existing boarding ?

  Yes

  No

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

  Yes

  No

• Has the boarded area got insulation under it ?

  Yes

  No

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

  Select Yes No

  • Yes
  • No

• Is a Walkway required ?

  Yes

  No

• Details of walkway

• Loft clearance (customer belongings) ?

  Yes

  No

• Details of loft clearance

• How many man hours estimated for clearance ?

• Select customer instruction

  Select Empty and replace after install Empty and leave out of loft Empty and replace approx half - customer to dispose of half

  • Empty and replace after install
  • Empty and leave out of loft
  • Empty and replace approx half - customer to dispose of half

If funding available please answer additional ventilation questions below.

• Ventilation Survey ? If responsible for funding, select YES.

  Yes

  No

  N/A

• Are there any visible signs of surface condensation or damp ?

  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 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 form 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 in unused areas.

  Select Yes No N/A

  • 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 information been left behind?

  Yes

  No

  N/A

• Is a condensation calculation required? If so which elements?

  Yes

  No

  N/A

• Is cold bridge insulation to be installed?

  Yes

  No

• Can we install 50mm of rigid insulation to board to 100% of the perimeter leaving the ventilation gap?

  Yes

  No

• If no, why not? Is there a solution (known options, roof etc.)

• What is the joist depth?

  100mm (inc 100mm +)

  75mm

  65mm or less

• What are the joist centres?

  600mm

  400mm

  Random cuts required

• Which description best matches the property?

  Select Front and rear only - two elevations Hip roof three sides - 3 elevations Front and rear plus accessible off shot - Random draw

  • Front and rear only - two elevations
  • Hip roof three sides - 3 elevations
  • Front and rear plus accessible off shot - Random draw

• Total linear metre(s) to be installed? (to one decimal place)

• Is there any additional work required? Describe work + estimate time + material needed

• Are plastic cuts for ventilation required (NCA housing only) ?

  Yes

  No

• Are door undercuts required ?

  Yes

  No

• How many?

• Which rooms

  Select Living Kitchen Bathroom Bed 1 Bed 2 Bed 3 Dinning Living 2 Utility Bed 4 Other 1 Other 2 Other 3

  • Living
  • Kitchen
  • Bathroom
  • Bed 1
  • Bed 2
  • Bed 3
  • Dinning
  • Living 2
  • Utility
  • Bed 4
  • Other 1
  • Other 2
  • Other 3

Dynamic Risk Assessment.

• Please select yes if loft insulation work to be undertaken.

  Yes

  No

• Reversing vehicle ?

  Yes

  No

• Asbestos present ?

  Yes

  No

• Overhead electricity cables ?

  Yes

  No

• Use of an extendable ladders (internal or external) required ?

  Yes

  No

• Use of a non-extendable ladder required ?

  Yes

  No

• Use of access equipment required?

  Yes

  No

• Manual Handling assessment required ?

  Yes

  No

• Hand tools, passive and mechanical used ?

  Yes

  No

• Vibration risk - from tool use ?

  Yes

  No

• Noise - protection required (>85db mandatory) ?

  Yes

  No

• House keeping (Dust sheets, cleaning equipment)

  Yes

  No

• Lone worker assessment required?

  Select Lone worker - safe Must be team of at least two Must be a team of at least three (two on site all times)

  • Lone worker - safe
  • Must be team of at least two
  • Must be a team of at least three (two on site all times)

• I have assessed the conditions on site, there is adequate ventilation, no evidence of damp and no remedial works is required. Unless listed below, there are no additional significant hazards observed that are not addressed in the generic risk assessment prepared for the work to be undertaken.

  None

  See Below

• Assessor signature

  Sign

Installation checks to be completed by technician after the work as been completed.

• Ignore - Please select yes if loft insulation work to be installed.

  Yes

  No

• Crew leader name:

• No 2 technician:

• Date.

• Crew leader signature.

• Materials used:

• Roll Matt 100mm

• Roll Matt 150mm

• Roll Matt 170mm

• Roll Matt 200mm

• Roll Matt 250mm

• Roll Matt 270mm

• Roll Matt 300mm

• Pipe lagging 15mm

• Pipe lagging 22mm

• Pipe lagging 28mm

• Pipe wrap per metre

• Cold water tank jacket small

• Cold water tank jacket medium

• Cold water tank jacket large

• Hot water tank jacket

• Poly wedges installed

• Customer signature: