PIBI AND TECH SURVEY FORM - ALL MEASURES

CONTACT DETAILS

• PROPERTY ADDRESS

• SURVEY DATE

  Date

• Customer in

  YES

  NO

  N/A

• PROPERTY TYPE

  Select HOUSE BUNGALOW FLAT MAISONETTE DETACHED SEMI DETACHED MID TERRACED END TERRACED 1 BED 2 BED 3 BED 4 BED 5 BED pre 1930's 2012 onwards 2007- 2011 2003 - 2006 1996 - 2002 1991 - 1995 1983 - 1990 1983-1990 1976 - 1982 1967 - 1975 1960 - 1966 1950 - 1965 1930 - 1949 1900 - 1929 before 1900 GROUND FLOOR MIDDLE FLOOR TOP FLOOR

  • HOUSE
  • BUNGALOW
  • FLAT
  • MAISONETTE
  • DETACHED
  • SEMI DETACHED
  • MID TERRACED
  • END TERRACED
  • 1 BED
  • 2 BED
  • 3 BED
  • 4 BED
  • 5 BED
  • pre 1930's
  • 2012 onwards
  • 2007- 2011
  • 2003 - 2006
  • 1996 - 2002
  • 1991 - 1995
  • 1983 - 1990
  • 1983-1990
  • 1976 - 1982
  • 1967 - 1975
  • 1960 - 1966
  • 1950 - 1965
  • 1930 - 1949
  • 1900 - 1929
  • before 1900
  • GROUND FLOOR
  • MIDDLE FLOOR
  • TOP FLOOR

SURVEYOR DETAILS

• SURVEYOR NAME

• CONTACT DETAILS

  07534 419 217

PROPERTY DETAILS

• PROPERTY IN AN EXPOSED AREA

  YES

  NO

  N/A

• PROPERTY IN A CONSERVATION AREA

  YES

  NO

  N/A

• PERMISSIONS APPROVED

  Yes

  No

  NA

DESIGN INFO

• DESIGN AND FLOOR PLANS UPLOADED

  Yes

  No

  NA

• MTRP READ AND UNDERSTOOD

  Yes

  No

  NA

• ASBESTOS REPORT UPLOADED

  Yes

  No

  NA

• SOLAR PV DESIGN UPLOADED

  Yes

  No

  NA

• ASHP DESIGN UPLOADED

  Yes

  No

  NA

RECOMMENDED MEASURES

• DESIGN TEAM RECOMMENDED MEASURES

  Select CAVITY WALL INSULATION CAVITY WALL EXTRACT LOFT INSULATION EXTERNAL WALL INSULATION INTERNAL WALL INSULATION SOLAR PV SOLAR BATTERY DMEV DMVHR DOOR UNDERCUTS TRICKLE VENTS WINDOWS DOORS FULL HEATING AND ASHP INSTALL HHRSH HOT WATER CYLINDER EDDIE ( SOLAR DIVERTER ) REPLACEMENT ROOF REMEDIALS low energy lighting decommission existing heating system Airex Aerogel LOFT HATCH REPLACEMENT ADD HOT WATER CYLINDER WITH A TWIN IMMERSION REPLACE HOT WATER CYLINDER Draught proof existing loft hatch Draught proof and insulate loft hatch

  • CAVITY WALL INSULATION
  • CAVITY WALL EXTRACT
  • LOFT INSULATION
  • EXTERNAL WALL INSULATION
  • INTERNAL WALL INSULATION
  • SOLAR PV
  • SOLAR BATTERY
  • DMEV
  • DMVHR
  • DOOR UNDERCUTS
  • TRICKLE VENTS
  • WINDOWS
  • DOORS
  • FULL HEATING AND ASHP INSTALL
  • HHRSH
  • HOT WATER CYLINDER
  • EDDIE ( SOLAR DIVERTER )
  • REPLACEMENT ROOF
  • REMEDIALS
  • low energy lighting
  • decommission existing heating system
  • Airex
  • Aerogel
  • LOFT HATCH REPLACEMENT
  • ADD HOT WATER CYLINDER WITH A TWIN IMMERSION
  • REPLACE HOT WATER CYLINDER
  • Draught proof existing loft hatch
  • Draught proof and insulate loft hatch

• ADDITIONAL MEASURES IDENTIFIED AT PIBI STAGE

  Select Not Applicable SEE NOTES Cavity wall extract Cavity wall refill cavity wall insulation loft insulation window replacement door replacement DMEV DMVHR Door undercuts Solar PV Battery REMEDIALS Roof replacement EWI EWI EXTRACT low Energy Lighting Airex Aerogel draught proof and insulate loft hatch Draught proof loft hatch

  • Not Applicable
  • SEE NOTES
  • Cavity wall extract
  • Cavity wall refill
  • cavity wall insulation
  • loft insulation
  • window replacement
  • door replacement
  • DMEV
  • DMVHR
  • Door undercuts
  • Solar PV
  • Battery
  • REMEDIALS
  • Roof replacement
  • EWI
  • EWI EXTRACT
  • low Energy Lighting
  • Airex
  • Aerogel
  • draught proof and insulate loft hatch
  • Draught proof loft hatch

• Measures That Need Amended

  Select Not applicable SEE NOTES ASHP outdoor unit location Hot water Cylinder location Solar array location Inverter location Battery location Radiator selection Cavity wall extract Cavity wall insulation Loft insulation EWI Windows External doors Ventilation DMEV DMVHR Solar Array design Change Draught proof and insulate loft hatch Draught proof loft hatch EXCLUDE SOLAR PV BATTERY ( SEE NOTES )

  • Not applicable
  • SEE NOTES
  • ASHP outdoor unit location
  • Hot water Cylinder location
  • Solar array location
  • Inverter location
  • Battery location
  • Radiator selection
  • Cavity wall extract
  • Cavity wall insulation
  • Loft insulation
  • EWI
  • Windows
  • External doors
  • Ventilation DMEV
  • DMVHR
  • Solar Array design Change
  • Draught proof and insulate loft hatch
  • Draught proof loft hatch
  • EXCLUDE SOLAR PV BATTERY ( SEE NOTES )

PRODUCT SPECIFICATIONS UPLOADED

• VENTILATION

  Yes

  No

  NA

• SOLAR PV

  Yes

  No

  NA

• AIR SOURCE HEAT PUMP

  Yes

  No

  NA

• HHRSH

  Yes

  No

  NA

• CAVITY WALL INSULATION

  Yes

  No

  NA

• EXTERNAL WALL INSULATION

  Yes

  No

  NA

• LOFT INSULATION

  Yes

  No

  NA

EXTERNAL ELEVATION PHOTOS

• ALL EXTERNAL ELEVATION PHOTOS TAKEN

  Yes

  No

  NA

ROOF TYPE

• ROOF STYLE

  STANDARD

  HIPPED

  OTHER

• STRUCTURAL SURVEY REQUIRED

  YES

• ROOF TILE TYPE

  DOUBLE ROMAN

  FLAT

  OTHER

• ROOF COVERING MATERIAL

  CLAY

  CONCRETE

  SLATE

EXTERNAL DEFECTS / AIR INGRESS

• NOTES Condition of roof , facias , soffits , etc

• NOTES Condition of external walls , ( identify cracks , holes , etc. )

• STRUCTURAL SURVEY REQUIRED

  YES

  NO

  N/A

• ADDITIONAL NOTES

SCAFFOLD SURVEY

• Scaffold required

  YES

  NO

  N/A

• ELEVATIONS

  Select front Back Left Right

  • front
  • Back
  • Left
  • Right

• Scaffold for what measures

  Select Solar PV EWI Window replacement Roof replacement Remedials

  • Solar PV
  • EWI
  • Window replacement
  • Roof replacement
  • Remedials

• GROUND TO GUTTER HEIGHT in meters

• GROUND CONDITION

• EDGE PROTECTION REQUIRED

  Yes

  No

  NA

• ACCESS ISSUES

• ANY OBSTRUCTIONS ( CONSERVATORY , LEAN TO etc )

• PAVEMENT PERMIT REQUIRED ( 1.5M CLEARANCE REQUIRED )

  YES

  NO

  N/A

SERVICE METERS

• ELECTRIC METER LOCATION

  Select INTERNAL EXTERNAL FRONT BACK LEFT RIGHT SEE NOTES UNDER STAIRS Lounge Kitchen Dining room Bathroom WC No Mains Gas

  • INTERNAL
  • EXTERNAL
  • FRONT
  • BACK
  • LEFT
  • RIGHT
  • SEE NOTES
  • UNDER STAIRS
  • Lounge
  • Kitchen
  • Dining room
  • Bathroom
  • WC
  • No Mains Gas

• ELECTRIC METER BOX EVIDENCE

  Select DIAL SMART DIGITAL KEY METER SINGLE METER DUAL METER SEPERATE ECONOMY 7 METER MAIN ISOLATOR NOT PRESENT MAIN ISOLATOR PRESENT 60 AMP FUSE 80 AMP FUSE 100 AMP FUSE UNKNOWN FUSE AMP

  • DIAL
  • SMART
  • DIGITAL
  • KEY METER
  • SINGLE METER
  • DUAL METER
  • SEPERATE ECONOMY 7 METER
  • MAIN ISOLATOR NOT PRESENT
  • MAIN ISOLATOR PRESENT
  • 60 AMP FUSE
  • 80 AMP FUSE
  • 100 AMP FUSE
  • UNKNOWN FUSE AMP

• GAS METER LOCATION

  Select INTERNAL EXTERNAL FRONT BACK LEFT RIGHT SEE NOTES UNDER STAIRS Lounge Kitchen Dining room Bathroom WC No Mains Gas

  • INTERNAL
  • EXTERNAL
  • FRONT
  • BACK
  • LEFT
  • RIGHT
  • SEE NOTES
  • UNDER STAIRS
  • Lounge
  • Kitchen
  • Dining room
  • Bathroom
  • WC
  • No Mains Gas

CONSUMER UNIT

• ELECTRICAL WORKS

  YES

  NO

  NA

• CONSUMER UNIT LOCATION

  Select INTERNAL EXTERNAL FRONT BACK LEFT RIGHT SEE NOTES UNDER STAIRS Lounge Kitchen Dining room Bathroom WC No Mains Gas

  • INTERNAL
  • EXTERNAL
  • FRONT
  • BACK
  • LEFT
  • RIGHT
  • SEE NOTES
  • UNDER STAIRS
  • Lounge
  • Kitchen
  • Dining room
  • Bathroom
  • WC
  • No Mains Gas

• EXISTING CONSUMER UNIT SPARE WAYS ( SPD NEEDED NEEDED FOR PV )

  Select AS PER DESIGN SHEET NONE 1 2 3 4 5 6 7 8 9 10 SPD NEEDED SPD INSTALLED Not applicable

  • AS PER DESIGN SHEET
  • NONE
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • SPD NEEDED
  • SPD INSTALLED
  • Not applicable

• RCD PROTECTED ?

  YES

  NO

  NOT APPLICABLE

• RANGE

• MCB TYPE

• CONSUMER UNIT UPGRADE

  Select YES NO SUB BOARD ( MINIMUM 4 SPARE WAYS ) REPLACE EXISTING CONSUMER UNIT UPGRADE EXISTING CONSUMER UNIT

  • YES
  • NO
  • SUB BOARD ( MINIMUM 4 SPARE WAYS )
  • REPLACE EXISTING CONSUMER UNIT
  • UPGRADE EXISTING CONSUMER UNIT

SOLAR PV ARRAY

• INSTALLING SOLAR PV

  Yes

  No

  NA

• NUMBER OF PANELS

  Select AS PER DESIGN SHEET Not applicable NONE 1 2 3 4 5 6 7 8 9 10 11 12

  • AS PER DESIGN SHEET
  • Not applicable
  • NONE
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• ARRAY DESIGN

  Select PORTRAIT LANDSCAPE LANDSCAPE AND PORTRAIT NOT APPLICABLE IN ROOF ON ROOF

  • PORTRAIT
  • LANDSCAPE
  • LANDSCAPE AND PORTRAIT
  • NOT APPLICABLE
  • IN ROOF
  • ON ROOF

• EXPOSED LOCATION

  YES

  NO

  NA

• PROPOSED ELEVATION

  Select front Back Left Right

  • front
  • Back
  • Left
  • Right

• SOLAR ARRAY VISABLE FROM THE ROAD

  YES

  NO

  NA

• PLANNING PERMISSION REQUIRED

  YES

  NO

  N/A

SOLAR INVERTER SURVEY

• INVERTER BEING INSTALLED

  YES

  NOT APPLICABLE

  NO

• PROPESED INVERTER LOCATION

• SMOKE DETECTOR REQUIRED

  YES

  NO

  N/A

• INVERTER TO ROOF DISTANCE in meters

• INVERTER TO CONSUMER UNIT DISTANCE in meters

• Solar Diverter Required

  YES

  NO

  NA

• NOTES SECTION

SOLAR BATTERY SURVEY

• SOLAR BATTERY SPECIFIED

  YES

  NO

  NA

• PROPOSED LOCATION

  Select FRONT BACK LEFT SIDE RIGHT SIDE FRONT PORCH BACK PORCH SINGLE STOREY EXTENSION (FRONT ) SINGLE STOREY EXTENSION ( BACK ) GARAGE

  • FRONT
  • BACK
  • LEFT SIDE
  • RIGHT SIDE
  • FRONT PORCH
  • BACK PORCH
  • SINGLE STOREY EXTENSION (FRONT )
  • SINGLE STOREY EXTENSION ( BACK )
  • GARAGE

• EXTERNAL LOCATION SUITABLE

  Yes

  No

  NA

• Yes

  No

  NA

• 2 METER CLEARANCE FROM IGNITION SOURCE

  YES

  NO

  N/A

• 1 METER CLEARANCE FROM AN OPENING

  YES

  NO

  N/A

• 1 METER FROM BOUNDARY

  YES

  NO

  N/A

• FIRE RETARDANT SEPERATION REQUIRED

  YES

  NO

  N/A

• NOTES

• ALTERNATIVE INTERNAL LOCATION SUITABLE

  Yes

  No

  NA

• PROPOSED ALTERNATIVE LOCATION

• HARD WIRED SMOKE DETECTOR REQUIRED

  YES

  NO

  NA

• NOTES SECTION

REPLACE LIGHTING

• REPLACE LIGHT BULBS

  YES

  NO

  NA

• Bulb x

• Batten x

• Bulk head

DOOR UNDERCUTS

• DOOR UNDERCUTS REQUIRED

  YES

  NO

  NA

• DOOR UNDERCUTS LOCATIONS

  Select AS PER DESIGN SHEET LOUNGE KITCHEN DINING ROOM W/C ENTRANCE HALL LANDING BED 1 BED 2 BED 3 BED 4 BED 5 BATHROOM EN SUITE NOT APPLICABLE TBC ALL WINDOWS SEE NOTES AIRING CUPBOARD UNDER STAIRS GARAGE

  • AS PER DESIGN SHEET
  • LOUNGE
  • KITCHEN
  • DINING ROOM
  • W/C
  • ENTRANCE HALL
  • LANDING
  • BED 1
  • BED 2
  • BED 3
  • BED 4
  • BED 5
  • BATHROOM
  • EN SUITE
  • NOT APPLICABLE
  • TBC
  • ALL WINDOWS
  • SEE NOTES
  • AIRING CUPBOARD
  • UNDER STAIRS
  • GARAGE

• NUMBER OF UNDERCUTS

  Select YES NO 1 2 3 4 5 6 7 8 9 10

  • YES
  • NO
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

VENTILATION

• INSTALLING OR REPLACING DMEV

  YES

  NO

  NA

• EXISTING DMEV LOCATION

  Select KITHEN CEILING KITCHEN WALL NONE IN KITCHEN BATHROOM CEILING BATHROOM WALL NONE IN BATHROOM W/C CEILING W/C WALL NONE IN W/C ENSUITE CEILING ENSUITE WALL NOT APPLICABLE None TBC Kitchen Window Bathroom window KEEP EXISTING BATHROOM DMEV KEEP EXISTING KITCHEN DMEV KEEP EXISTING W/C/ DMEV KEEP EXISTING ENSUITE DMEV KEEP EXISTING UTILITY ROOM DMEV

  • KITHEN CEILING
  • KITCHEN WALL
  • NONE IN KITCHEN
  • BATHROOM CEILING
  • BATHROOM WALL
  • NONE IN BATHROOM
  • W/C CEILING
  • W/C WALL
  • NONE IN W/C
  • ENSUITE CEILING
  • ENSUITE WALL
  • NOT APPLICABLE
  • None
  • TBC
  • Kitchen Window
  • Bathroom window
  • KEEP EXISTING BATHROOM DMEV
  • KEEP EXISTING KITCHEN DMEV
  • KEEP EXISTING W/C/ DMEV
  • KEEP EXISTING ENSUITE DMEV
  • KEEP EXISTING UTILITY ROOM DMEV

• NEW DMEV LOCATION

  Select KITHEN CEILING KITCHEN WALL NONE IN KITCHEN BATHROOM CEILING BATHROOM WALL NONE IN BATHROOM W/C CEILING W/C WALL NONE IN W/C ENSUITE CEILING ENSUITE WALL NOT APPLICABLE None TBC Kitchen Window Bathroom window KEEP EXISTING BATHROOM DMEV KEEP EXISTING KITCHEN DMEV KEEP EXISTING W/C/ DMEV KEEP EXISTING ENSUITE DMEV KEEP EXISTING UTILITY ROOM DMEV

  • KITHEN CEILING
  • KITCHEN WALL
  • NONE IN KITCHEN
  • BATHROOM CEILING
  • BATHROOM WALL
  • NONE IN BATHROOM
  • W/C CEILING
  • W/C WALL
  • NONE IN W/C
  • ENSUITE CEILING
  • ENSUITE WALL
  • NOT APPLICABLE
  • None
  • TBC
  • Kitchen Window
  • Bathroom window
  • KEEP EXISTING BATHROOM DMEV
  • KEEP EXISTING KITCHEN DMEV
  • KEEP EXISTING W/C/ DMEV
  • KEEP EXISTING ENSUITE DMEV
  • KEEP EXISTING UTILITY ROOM DMEV

RIGID DUCTING

• RIDGED DUCTING REQUIRED

  YES

  NO

  N/A
ROOM IDENTIFIER

• ROOM IDENTIFIER

  Select BATHROOM KITCHEN W/C EN SUITE NOT APPLICABLE YES NO

  • BATHROOM
  • KITCHEN
  • W/C
  • EN SUITE
  • NOT APPLICABLE
  • YES
  • NO

• LENGTH OF RIGID DUCTING IN METERS

• Bends Required

  Select 1 x 2 x 3 x 4 x 90 Bend 45 Bend NOT APPLICABLE

  • 1 x
  • 2 x
  • 3 x
  • 4 x
  • 90 Bend
  • 45 Bend
  • NOT APPLICABLE

• INSTALLING OR REPLACING DMVHR

  YES

  NO

  NA

• EXISTING DMVHR LOCATIONS

  Select NOT APPLICABLE None Lounge Dining room bedroom 1 bedroom 2 bedroom 3 bedroom 4 bedroom 5 Other see notes Lounge window dining room window bedroom 1 window bedroom 2 window bedroom 3 window bedroom 4 window

  • NOT APPLICABLE
  • None
  • Lounge
  • Dining room
  • bedroom 1
  • bedroom 2
  • bedroom 3
  • bedroom 4
  • bedroom 5
  • Other see notes
  • Lounge window
  • dining room window
  • bedroom 1 window
  • bedroom 2 window
  • bedroom 3 window
  • bedroom 4 window

• NEW DMVHR LOCATIONS

  Select NOT APPLICABLE None Lounge Dining room bedroom 1 bedroom 2 bedroom 3 bedroom 4 bedroom 5 Other see notes Lounge window dining room window bedroom 1 window bedroom 2 window bedroom 3 window bedroom 4 window

  • NOT APPLICABLE
  • None
  • Lounge
  • Dining room
  • bedroom 1
  • bedroom 2
  • bedroom 3
  • bedroom 4
  • bedroom 5
  • Other see notes
  • Lounge window
  • dining room window
  • bedroom 1 window
  • bedroom 2 window
  • bedroom 3 window
  • bedroom 4 window

EXTERNAL DOORS AND WINDOWS

• EXTERNAL DOORS TO BE REPLACED

  YES

  NO

  NA

• REPLACE EXTERNAL DOOR

  Select FRONT BACK PATIO DOORS NONE AS PER DESIGN SHEET

  • FRONT
  • BACK
  • PATIO DOORS
  • NONE
  • AS PER DESIGN SHEET
DOOR MEASUREMENTS

• ROOM IDENTIFIER

  Select ENTRANCE HALL FRONT PRORCH LOUNGE KITCHEN DINING ROOM SEE NOTES

  • ENTRANCE HALL
  • FRONT PRORCH
  • LOUNGE
  • KITCHEN
  • DINING ROOM
  • SEE NOTES

• Width x Height

WINDOW MEASUREMENTS

• WINDOWS TO BE REPLACED

  YES

  NO

  NA
WINDOW MEASUREMENTS

• ROOM IDENTIFIER

  Select NOT APPLICABLE None Lounge Dining room bedroom 1 bedroom 2 bedroom 3 bedroom 4 bedroom 5 Other see notes Lounge window dining room window bedroom 1 window bedroom 2 window bedroom 3 window bedroom 4 window

  • NOT APPLICABLE
  • None
  • Lounge
  • Dining room
  • bedroom 1
  • bedroom 2
  • bedroom 3
  • bedroom 4
  • bedroom 5
  • Other see notes
  • Lounge window
  • dining room window
  • bedroom 1 window
  • bedroom 2 window
  • bedroom 3 window
  • bedroom 4 window

• WIDTH X HEIGHT

LOFT SURVEY

• LOFT HATCH TO BE REPLACED

  YES

  NO

  NA

• HATCH DIMENSIONS IN MM

• Are there any Bats / Rodents / Birds / Bees in the loft

  YES

  NO

  N/A

• LOFT FELT CONDITION

  Select GOOD CONDITION AVERAGE CONDITION POOR CONDITION SEE NOTES

  • GOOD CONDITION
  • AVERAGE CONDITION
  • POOR CONDITION
  • SEE NOTES

• NOTES

• ROOF PITCH IN METERS

• EXISTING LOFT VENTS

  Select YES NO 1 2 3 4 5 6 7 8 9 10

  • YES
  • NO
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• RAFTER MOISTURE READINGS

• HOW MUCH BELOGINGS IN LOFT

  LOFT FULL

  LOFT HAS A FEW BELONGINGS

  LOFT IS EMPTY OF BELONGINGS

  LOFT HALF FULL

• LOFT TO BE CLEARED

  YES

  NO

  N/A

• FOR WHAT MEASURES

  Select LOFT INSULATION SOLAR PV VENTILATION ROOF REPLACEMENT ROOF WORKS REMEDIALS

  • LOFT INSULATION
  • SOLAR PV
  • VENTILATION
  • ROOF REPLACEMENT
  • ROOF WORKS
  • REMEDIALS

• LOFT TO BE INSULATED

  YES

  NO

  NA

• EXISTING INSULATION DEPTH in mm

• INSULATION TOTAL DEPTH REQUIRED

  Select NOT APPLICABLE 400mm 350mm 270mm 200mm 150mm 100mm

  • NOT APPLICABLE
  • 400mm
  • 350mm
  • 270mm
  • 200mm
  • 150mm
  • 100mm

• EXISTING INSULATION TO BE REMOVED

  YES

  NO

• CUSTOMER AWARE LOFT WILL NEED TO BE CLEARED

  Select YES NO N/A FOR EWI ASHP SOLAR PV LOFT INSULATION

  • YES
  • NO
  • N/A
  • FOR EWI
  • ASHP
  • SOLAR PV
  • LOFT INSULATION

• NOTES SECTION

• STRUCTURAL SURVEY REQUIRED

  YES

  NO

• REASON FOR STRUCTURAL SURVEY

CAVITY WALL SURVEY

• INSTALLING CAVITY WALL INSULATION ?

  YES

  NO

  NA

• BOROSCOPE PHOTOS TAKEN ( EACH ELEVATION )

  Yes

  No

  NA

• WALL TYPE

  Select EMPTY CAVITY CAVITY INSULATED FIBRE CAVITY INSULATED BEAD FAILED CAVITY INSULATION PARTIAL FILLED TIMBER FRAMED SOLID WALL SEE NOTES

  • EMPTY CAVITY
  • CAVITY INSULATED FIBRE
  • CAVITY INSULATED BEAD
  • FAILED CAVITY INSULATION
  • PARTIAL FILLED
  • TIMBER FRAMED
  • SOLID WALL
  • SEE NOTES

• CAVITY DEPTH

  Select 50mm 60mm 70mm 80mm + LESS THAN 50mm

  • 50mm
  • 60mm
  • 70mm
  • 80mm +
  • LESS THAN 50mm

• INSTALL CAVITY WALL INSULATION TO EMPTY CAVITY

  YES

  NO

  NA

• EXTRACT AND REFILL

  YES

  NO

  N/A

• NOTES

• Reason for not installing CW insulation

  Select EMPTY CAVITY CAVITY INSULATED FIBRE CAVITY INSULATED BEAD FAILED CAVITY INSULATION PARTIAL FILLED TIMBER FRAMED SOLID WALL SEE NOTES

  • EMPTY CAVITY
  • CAVITY INSULATED FIBRE
  • CAVITY INSULATED BEAD
  • FAILED CAVITY INSULATION
  • PARTIAL FILLED
  • TIMBER FRAMED
  • SOLID WALL
  • SEE NOTES

EXTERNAL WALL INSULATION SURVEY

• External wall insulation

  YES

  NO

  NA

• PROPERTY CONSTRUCTION

  CAVITY WALL

  SOLID BRICK

  PRE - FAB

  NON TRADITIONAL

  OTHER ( SEE NOTES )

• EXISTING FINISH

  Select STONE BRICK SAND AND CEMENT RENDER MASS CONCRETE DRY DASH WET DASH CONCRETE BLOCK WOOD PAINT

  • STONE
  • BRICK
  • SAND AND CEMENT RENDER
  • MASS CONCRETE
  • DRY DASH
  • WET DASH
  • CONCRETE BLOCK
  • WOOD PAINT

• ELEVATIONS REQUIRING EWI

  Select FRONT BACK LEFT SIDE RIGHT SIDE FRONT PORCH BACK PORCH SINGLE STOREY EXTENSION (FRONT ) SINGLE STOREY EXTENSION ( BACK ) GARAGE

  • FRONT
  • BACK
  • LEFT SIDE
  • RIGHT SIDE
  • FRONT PORCH
  • BACK PORCH
  • SINGLE STOREY EXTENSION (FRONT )
  • SINGLE STOREY EXTENSION ( BACK )
  • GARAGE

• IS THE PROPERTY SUITABLE FOR EWI

  YES

  NO

  N/A

• Remove existing Failed EWI ?

  YES

  NO

  N/A

• IDENTIFY FRONT ELEVATION SERVICES

  Select Not applicable ROOM VENTS WASTE PIPE ARIEL SATELLITE DISH SUB FLOOR VENTS ESB METER BOX GAS METER BOX ALARM BOX BOILER FLUE EXTRACTOR VENT OUTDOOR LIGHT SOCKET CLOTHES LINE GARDEN TAP ADDITIONAL (SEE NOTES ) RAIWATER DOWN PIPES SECURITY CAMERAS FACIAS Soffits Fibre optic cables Washing line External light

  • Not applicable
  • ROOM VENTS
  • WASTE PIPE
  • ARIEL
  • SATELLITE DISH
  • SUB FLOOR VENTS
  • ESB METER BOX
  • GAS METER BOX
  • ALARM BOX
  • BOILER FLUE
  • EXTRACTOR VENT
  • OUTDOOR LIGHT SOCKET
  • CLOTHES LINE
  • GARDEN TAP
  • ADDITIONAL (SEE NOTES )
  • RAIWATER DOWN PIPES
  • SECURITY CAMERAS
  • FACIAS
  • Soffits
  • Fibre optic cables
  • Washing line
  • External light

• IDENTIFY REAR ELEVATION SERVICES

  Select Not applicable ROOM VENTS WASTE PIPE ARIEL SATELLITE DISH SUB FLOOR VENTS ESB METER BOX GAS METER BOX ALARM BOX BOILER FLUE EXTRACTOR VENT OUTDOOR LIGHT SOCKET CLOTHES LINE GARDEN TAP ADDITIONAL (SEE NOTES ) RAIWATER DOWN PIPES SECURITY CAMERAS FACIAS Soffits Fibre optic cables Washing line External light

  • Not applicable
  • ROOM VENTS
  • WASTE PIPE
  • ARIEL
  • SATELLITE DISH
  • SUB FLOOR VENTS
  • ESB METER BOX
  • GAS METER BOX
  • ALARM BOX
  • BOILER FLUE
  • EXTRACTOR VENT
  • OUTDOOR LIGHT SOCKET
  • CLOTHES LINE
  • GARDEN TAP
  • ADDITIONAL (SEE NOTES )
  • RAIWATER DOWN PIPES
  • SECURITY CAMERAS
  • FACIAS
  • Soffits
  • Fibre optic cables
  • Washing line
  • External light

• IDENTIFY RIGHT SIDE ELEVATION SERVICES

  Select Not applicable ROOM VENTS WASTE PIPE ARIEL SATELLITE DISH SUB FLOOR VENTS ESB METER BOX GAS METER BOX ALARM BOX BOILER FLUE EXTRACTOR VENT OUTDOOR LIGHT SOCKET CLOTHES LINE GARDEN TAP ADDITIONAL (SEE NOTES ) RAIWATER DOWN PIPES SECURITY CAMERAS FACIAS Soffits Fibre optic cables Washing line External light

  • Not applicable
  • ROOM VENTS
  • WASTE PIPE
  • ARIEL
  • SATELLITE DISH
  • SUB FLOOR VENTS
  • ESB METER BOX
  • GAS METER BOX
  • ALARM BOX
  • BOILER FLUE
  • EXTRACTOR VENT
  • OUTDOOR LIGHT SOCKET
  • CLOTHES LINE
  • GARDEN TAP
  • ADDITIONAL (SEE NOTES )
  • RAIWATER DOWN PIPES
  • SECURITY CAMERAS
  • FACIAS
  • Soffits
  • Fibre optic cables
  • Washing line
  • External light

• IDENTIFY LEFT SIDE ELEVATION SERVICES

  Select Not applicable ROOM VENTS WASTE PIPE ARIEL SATELLITE DISH SUB FLOOR VENTS ESB METER BOX GAS METER BOX ALARM BOX BOILER FLUE EXTRACTOR VENT OUTDOOR LIGHT SOCKET CLOTHES LINE GARDEN TAP ADDITIONAL (SEE NOTES ) RAIWATER DOWN PIPES SECURITY CAMERAS FACIAS Soffits Fibre optic cables Washing line External light

  • Not applicable
  • ROOM VENTS
  • WASTE PIPE
  • ARIEL
  • SATELLITE DISH
  • SUB FLOOR VENTS
  • ESB METER BOX
  • GAS METER BOX
  • ALARM BOX
  • BOILER FLUE
  • EXTRACTOR VENT
  • OUTDOOR LIGHT SOCKET
  • CLOTHES LINE
  • GARDEN TAP
  • ADDITIONAL (SEE NOTES )
  • RAIWATER DOWN PIPES
  • SECURITY CAMERAS
  • FACIAS
  • Soffits
  • Fibre optic cables
  • Washing line
  • External light

• ROOF OVERHANG DIMENSIONS

• ROOF TO BE EXTENDED ?

  YES

  NO

  N/A

• INTERNAL WALL COVERING ?

  Select PLASTER SKIM PLASTERBOARD SAND CEMENT INSULATED PLASTERBOARD

  • PLASTER SKIM
  • PLASTERBOARD
  • SAND
  • CEMENT
  • INSULATED PLASTERBOARD

• DOES THE PROPERTY HAVE A CAVITY

  YES

  NO

  NA

• CONDITION OF CAVITY

  Select CLEAR RUBBLE IN CAVITY BELOW DAMP COURSE SNOTS ON WALL TIES OTHER ( SEE NOTES ) RUBBLE IN CAVITY ABOVE DAMP COURSE PATCHY INSULATION

  • CLEAR
  • RUBBLE IN CAVITY BELOW DAMP COURSE
  • SNOTS ON WALL TIES
  • OTHER ( SEE NOTES )
  • RUBBLE IN CAVITY ABOVE DAMP COURSE
  • PATCHY INSULATION

• DEPTH OF CAVITY

  Select 50mm 60mm 70mm 80mm + LESS THAN 50mm

  • 50mm
  • 60mm
  • 70mm
  • 80mm +
  • LESS THAN 50mm

• Boroscope photos taken ( each elevation)

  YES

  NO

  NA

• FILL EMPTY CAVITY / EXTRACT AND REFILL

  FILL EMPTY CAVITY

  EXTRACT AND REFILL

  OTHER ( SEE NOTES )

• ADDITIONAL NOTES

• REQUIRES A STRUCTURAL ENGINEER

  YES

  NO

  N/A

AIREX

• AIREX REQUIRED

  YES

  NO

  NA

• EXISTING FLOOR VENTS

  Select Not applicable 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 RADIATORS HRSH ESH ELECTRIC RADIATORS

  • Not applicable
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • RADIATORS
  • HRSH
  • ESH
  • ELECTRIC RADIATORS

• SINGLE BRICK AIREX REQUIRED

  Select Not applicable 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 RADIATORS HRSH ESH ELECTRIC RADIATORS

  • Not applicable
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • RADIATORS
  • HRSH
  • ESH
  • ELECTRIC RADIATORS

• DOUBLE BRICK AIREX REQUIRED ( SLEEVE REQUIRED )

  Select Not applicable 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 RADIATORS HRSH ESH ELECTRIC RADIATORS

  • Not applicable
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • RADIATORS
  • HRSH
  • ESH
  • ELECTRIC RADIATORS

REMEDIAL WORKS

• ROOF TO BE REPLACED

  YES

  NO

  NA

• NOTES

• STRUCTURAL SURVEY REQUIRED

  YES

  NO

  N/A

• INTERNAL REMEDIAL WORKS REQUIRED

  YES

  NO

  NA
ROOM IDENTIFIER

• LOCATION OF REMEDIAL WORKS

  Select AS PER DESIGN SHEET LOUNGE KITCHEN DINING ROOM W/C ENTRANCE HALL LANDING BED 1 BED 2 BED 3 BED 4 BED 5 BATHROOM EN SUITE NOT APPLICABLE TBC ALL WINDOWS SEE NOTES AIRING CUPBOARD UNDER STAIRS GARAGE

  • AS PER DESIGN SHEET
  • LOUNGE
  • KITCHEN
  • DINING ROOM
  • W/C
  • ENTRANCE HALL
  • LANDING
  • BED 1
  • BED 2
  • BED 3
  • BED 4
  • BED 5
  • BATHROOM
  • EN SUITE
  • NOT APPLICABLE
  • TBC
  • ALL WINDOWS
  • SEE NOTES
  • AIRING CUPBOARD
  • UNDER STAIRS
  • GARAGE

• NOTES

• STRUCTURAL SURVEY REQUIRED

  YES

  NO

  N/A

• NOTES

HHRSH

• INSTALLING STORAGE HEATERS ?

  Yes

  No

  NA

• EXISTING HEATING

  Select NO HEATING GAS ESH ELEC ASHP OIL LPG Solid fuel Combi boiler System boiler Regular boiler PARTIAL HEATED

  • NO HEATING
  • GAS
  • ESH
  • ELEC
  • ASHP
  • OIL
  • LPG
  • Solid fuel
  • Combi boiler
  • System boiler
  • Regular boiler
  • PARTIAL HEATED
ROOM IDENTIFIER

• ROOM IDENTIFIER

  Select AS PER DESIGN SHEET LOUNGE KITCHEN DINING ROOM W/C ENTRANCE HALL LANDING BED 1 BED 2 BED 3 BED 4 BED 5 BATHROOM EN SUITE NOT APPLICABLE TBC ALL WINDOWS SEE NOTES AIRING CUPBOARD UNDER STAIRS GARAGE

  • AS PER DESIGN SHEET
  • LOUNGE
  • KITCHEN
  • DINING ROOM
  • W/C
  • ENTRANCE HALL
  • LANDING
  • BED 1
  • BED 2
  • BED 3
  • BED 4
  • BED 5
  • BATHROOM
  • EN SUITE
  • NOT APPLICABLE
  • TBC
  • ALL WINDOWS
  • SEE NOTES
  • AIRING CUPBOARD
  • UNDER STAIRS
  • GARAGE

• EXISTING HEATER TYPE

  Select HHRSH ELECTRIC STORAGE HEATER ELECTRIC WALL HEATER NO EXISTING HEATER RADIATOR

  • HHRSH
  • ELECTRIC STORAGE HEATER
  • ELECTRIC WALL HEATER
  • NO EXISTING HEATER
  • RADIATOR

• DIMENSIONS Width x Height in mm

HOT WATER CYLINDER REPLACEMENT ONLY

• EXISTING HOT WATER CYLINDER

  Yes

  No

  NA

• LOCATION

• TYPE

  GRAVITY

  PRESSURISED

• IMMERSION

  SINGLE

  DOUBLE

  DUAL

• REPLACE IMMERSION

  YES

  NO

  N/A

• REPLACE HOT WATER CYLINDER

  YES

  NO

  N/A

ASHP SURVEY ( Full Heating System )

• HEAT PUMP SYSTEM BEING INSTALLED

  YES

  NOT APPLICABLE

  NO

• ASHP HEAT LOSS CALCULATION UPLOADED AND COMPLETED

  YES

  NO

  N/A

• CARRY OUT ROOM BY ROOM MEASUREMENTS <br> ( Separate Form )

  YES

  NO

  N/A

• EXISTING HEATING

  Select NO HEATING GAS ESH ELEC ASHP OIL LPG Solid fuel Combi boiler System boiler Regular boiler PARTIAL HEATED

  • NO HEATING
  • GAS
  • ESH
  • ELEC
  • ASHP
  • OIL
  • LPG
  • Solid fuel
  • Combi boiler
  • System boiler
  • Regular boiler
  • PARTIAL HEATED

• EXISTING HEATING CONTROLS

  Select Hard wired programmer Wireless programmable room stat Room stat TRV’s Smart controls On heater timer

  • Hard wired programmer
  • Wireless programmable room stat
  • Room stat
  • TRV’s
  • Smart controls
  • On heater timer

• EXISTING EMMITTERS

  Select Not applicable 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 RADIATORS HRSH ESH ELECTRIC RADIATORS

  • Not applicable
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • RADIATORS
  • HRSH
  • ESH
  • ELECTRIC RADIATORS

• EXISTING HOT WATER CYLINDER LOCATION

• EXITING HOT WATER CYLINDER TYPE

  GRAVITY

  PRESSURISED

• DIMENSION OF AVAILABLE SPACE in mm ( W x D x H )

• DOOR DIMENSIONS in mm ( W x H )

• ALTERNATIVE LOCATION IF REQUIRED

• VOLUMISER / BUFFER TANK PROPOSED LOCATION

  Select IN THE LOFT IN WITH THE HWC TBC

  • IN THE LOFT
  • IN WITH THE HWC
  • TBC

• PRESSURE RELIEF VAVE ROUTE

• NOTES

OUTDOOR UNIT LOCATION

• OUTDOOR UNIT BEING INSTALLED

  Yes

  No

  NA

• SITED TO DESIGN SPECIFICATION

  Yes

  No

  NA

• PROPOSED ALTERNATIVE LOCATION

  Select BACK ELEVATION FRONT ELEVATION LEFT ELEVATION RIGHT ELEVATION SEE PHOTO AND NOTES

  • BACK ELEVATION
  • FRONT ELEVATION
  • LEFT ELEVATION
  • RIGHT ELEVATION
  • SEE PHOTO AND NOTES

• 1 METER FROM THE BOUNDARY LINE

  YES

  NO

  N/A

• 2 METER CLEARANCE FROM PROPOSED PV BATTERY

  YES

  NO

  N/A

• EXISTING GROUND CONDITION

  Select FLAT SOFT GROUND FLAT HARD BASE UNEVEN SOFT GROUND PATIO AREA DECKED AREA CONCRETE BASE SEE NOTES

  • FLAT SOFT GROUND
  • FLAT HARD BASE
  • UNEVEN SOFT GROUND
  • PATIO AREA
  • DECKED AREA
  • CONCRETE BASE
  • SEE NOTES

• BASE FOR OUTDOOR UNIT

  Select use existing base concrete base required slabs and stone chippings required SEE NOTES

  • use existing base
  • concrete base required
  • slabs and stone chippings required
  • SEE NOTES

• CONDENSE ROUTE

  Select DRAIN SOAK AWAY REQUIRED LOOSE STONE CHIPS SEE NOTES

  • DRAIN
  • SOAK AWAY REQUIRED
  • LOOSE STONE CHIPS
  • SEE NOTES

• ACCESS TO SITE OUTDOOR UNIT

  Select THROUGH THE HOUSE THROUGH A GATE OR SIDE ENTRANCE ACCESS ISSUES SEE NOTES

  • THROUGH THE HOUSE
  • THROUGH A GATE OR SIDE ENTRANCE
  • ACCESS ISSUES SEE NOTES

• NOTES

ADDITIONAL NOTES REGARDING TENANT

• undefined

• Our installers will need for you to provide ease of access around the external elevations , in your loft and to all the rooms in your home to allow us to install your new energy saving measures

• all belonging in the loft to be removed prior to installing loft insulation ( for loft insulation top up works )
  

• I understand that the installation works will be carried out by LivGreen in Partnership with your local Housing Association

• Are you happy to proceed to the installation stage

  Yes

  No

  NA

• REASON TENANT DOES NOT WISH TO PROCEED

• Name of Customer & Signature

  Sign

• Select date

  Date