Information
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Location.
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Client Name.
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Contact Details.
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Tenure.
- Owner occupier
- Local Authority
- Housing Association
- Privately Rented
- Eco measure
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Scheme type.
- Owner occupier
- Local Authority
- Housing Association
- Privately Rented
- Eco measure
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Survey conducted by.
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Conducted on
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Building & Heating Information:
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Construction age of the building.
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Property Type.
- Mid-Terrace
- End terrace
- Semi-detached
- Detached
- Ground Floor Flat
- Middle Floor Flat
- Top Floor Flat
- Masonette
- Bungalow
- House
- Commercial Building
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Number of Bedrooms.
- 1
- 2
- 3
- 4
- 5+
- N/A Commercial
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Floor Construction Type
- Solid
- Suspended
- Suspended not wood
- Other
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Please take a photo of the front door
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Please take a photo of the Electric and Gas meters where applicable.
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Main Heating type
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Photo of appliance name/make/model/rating plate.
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Location of appliance ie Airing cupboard, Utility etc
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Location of the flue, please take a photo.
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Secondary heat source, please take a photo.
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Secondary Heat source type.
- 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
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Please state appliance, fuel type, flue type, location of appliance, size of appliance and ventilation requirements
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Location of Appliance ie Airing Cupboard, Utility Etc.
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Location of Chimney if present. Make note of which room in notes
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Location of Combustion vent if present. Make note of which rooms in notes
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Will the CWI installation work result in the unsafe operation of a combustion appliance e.g. Flue, Chimney
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Take Photos internally and externally of the vent
Cavity Survey Information
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Total Area of property
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Total area to be insulated.
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What is the extent of the cavity to be fill?
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Required material.
- Thermabead Carbon Saver
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Average Cavity Depth.
- 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
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Total area to be omitted.
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Photos of omitted areas.
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Does the building have any air vents.
- Yes
- No
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If yes please select.
- Underfloor vents
- Kitchen vents
- Bedroom vents
- Bathroom vents
- Combustion vent
- Extraction fan kitchen
- Extraction fan bathroom
- Pantry vents
- Window trickle vents
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Do any of the air vents require sleeving or sealing up before installing the cavities.
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Please select the type of ventilation present, including extraction ventilation and trickle vents.
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Please take a photo of all background vents and extraction fans fitted within the property including at least two photos of window trickle vents.
- Underfloor vents
- Kitchen vents
- Bedroom vents
- Bathroom vents
- Combustion vent
- Extraction fan kitchen
- Extraction fan bathroom
- Pantry vents
- Window trickle vents
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Adjoining properties insulated ?
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Number of Cavity brushes required.
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Core vent required.
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Number of core vents and location.
Front Elevation
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Do you wish to complete Front Elevation Measurements
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Total Area (a)
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Area to be omitted (b)
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Area to be installed (a-b)
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Photo of elevation
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Please take a photo of all gutters or down pipes on this elevation.
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Cavity Depth
- 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
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Take Photo showing tape in cavity showing depth
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Photo of Borescope in wall
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Borescope Photos.
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Please take a photo of the DPC, if not visible from outside take an internal photo using Borescope
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Is Internal drilling required, if yes provide notes and photos of the area
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Comments
Rear Elevation
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Do you wish to complete Rear Elevation Measurements
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Total Area (a)
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Area to be omitted (b)
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Area to be installed (a-b)
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Photo of elevation
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Please take a photo of all gutters or down pipes on this elevation.
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Cavity Depth
- 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
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Take Photo showing tape in cavity showing depth
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Photo of Borescope in wall
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Borescope Photos.
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Please take a photo of the DPC, if not visible from outside take an internal photo using Borescope
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Is Internal drilling required, if yes provide notes and photos of the area
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Comments
Right Hand Elevation
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Do you wish to complete Right Hand Elevation Measurements
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Total Area (a)
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Area to be omitted (b)
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Area to be installed (a-b)
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Photo of elevation
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Please take a photo of all gutters or down pipes on this elevation.
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Cavity Depth
- 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
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Take Photo showing tape in cavity showing depth
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Photo of Borescope in wall
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Borescope Photos.
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Please take a photo of the DPC, if not visible from outside take an internal photo using Borescope
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Is Internal drilling required, if yes provide notes and photos of the area
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Comments
Left hand elevation
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Do you wish to complete Left Hand Elevation Measurements
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Total Area (a)
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Area to be omitted (b)
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Area to be installed (a-b)
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Photo of elevation
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Please take a photo of all gutters or down pipes on this elevation.
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Cavity Depth
- 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
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Take Photo showing tape in cavity showing depth
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Photo of Borescope in wall
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Borescope Photos.
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Please take a photo of the DPC, if not visible from outside take an internal photo using Borescope
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Is Internal drilling required, if yes provide notes and photos of the area
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Comments
Building extensions
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Do you wish to complete Extension Measurements
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Total area (a)
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Area to be omitted (b)
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Area to be installed (a-b)
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Photo of elevation
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Please take a photo of all gutters or down pipes on this elevation.
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Cavity Depth
- 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
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Take Photo showing tape in cavity showing depth
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Boroscope Photos.
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Please take a photo of the DPC externally, if covered and not visible take an internal photo using Borescope
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Is Internal drilling required, if yes provide notes and photos of the area
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Comments
Construction details and Condition:
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Building Finish plus photos of all the elevations of the property.
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Type & Condition of the Building structure suitable for the work to commence? (If Ventilation required then choose NO)
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External Condition of the building.
- Very good
- Good
- Poor
- Very poor
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Is the property suitable to receive the insulation type specified?(Construction type, Exposer, Condition of Structure)
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Please take photo’s of plants or Ivy attached to property, please note these will need to be removed if they are attached to the building.
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Have you informed the client that the plants or Ivy will need to be removed.
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Have you done an internal inspection of the building? If yes please take photos of your findings.
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If you have answered yes please select the best description of your findings.
- 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.
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Safety monitors present.
- Smoke Alarm
- Fire Alarm
- CO2 Alarm
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Protected species or rodents present in building.
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Special Instructions.
Access
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On site parking.
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Client Instructions.
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Will the site layout or condition impair the execution of the work?
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Access Equipment Required.
- None
- Ladders
- Scaffold Board for Flat Roof
- Scaffolding
- Conservatory Ladder
- Roof Ladder
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If scaffolding required will it be supplied by the customer?
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Cavity Wall Insulation
Additional Photos
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Loft Hatch
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Left Gable Wall from inside loft
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Right Gable Wall From inside Loft
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Party Wall from inside Loft
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Photo of wall being measured windows (show both ends of tape) Must be able to see measurement clearly
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Close up brick pattern & mortar joints
PAS Questions
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Will the CWI installation work result in non compliance with building regulations e.g. Workmanship, Materials
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Will the CWI installation work result in compromise to the functionality of the existing ventilation ducts/systems
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Will the CWI installation work result in compromise to the functionality and/or safety of the existing services
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Will the CWI installation work result in the installation that is Non-compliant materials suppliers requirements
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Property drilled to establish clear cavity width
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All areas NOT to be insulated are agreed with the customer
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Any areas to be insulated vie the internal leaf agreed with the customer
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Is there any potential for moisture build upas a result of the installation?
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Will the functionality and/or safety of installed services (gas,electricity,water, telecommunications etc.) be affected in any way as a result of the installation?
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Is there any potential risk in relation to the ongoing performance of the installed services?
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From the findings of the survey, is the installation able to be carried out in line with the full design specification
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From the finding of the survey, is the method statement suitable and complete?
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Does the customer understand the nature and extent of the work?
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Have they been made aware of any disruption that may be caused (for example rubbish disposal and the siting of skips)
Dynamic Risk Assessment for Cavity Wall Insulation
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Use of a ladder/step ladder.
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Noise.
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Vibration.
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Manual Handing.
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Hand Tools/Power Tools
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Compressed air.
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Electricity/Generator
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House keeping/site tidiness.
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Working with with wet cement,concrete or mortar.
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Overhead cables.
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Reversing a vehicle.
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Asbestos.
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Use of a Mobile tower/MEWP
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Lone Worker.
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Signature
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Surveyor Please Sign Here
