Title Page
Details
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Client
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Who?
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Conducted on
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Prepared by
- Callam Taylor
- Freedom Energy
- DT Electrical
- Chris Houghton
- Daniel Montgomery
- Other
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Name of Competent Person
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Survey Type
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First Line of Address
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Front Elevation Photo
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Location
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Project
Customer & Electrics
Customer & Electric Details
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Current Energy Supplier
- Utilita
- British Gas
- EON
- EDF
- Octopus
- OVO
- nPower
- Scottish Power
- Boost
- Other
- Unknown
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Which Supplier?
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Smart Meter Installed?
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Electric Meter Photographic Evidence
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Fuse Board Photo
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Main Fuse Cut Out Rating
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Electricity Tariff Information
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What is the tariff name?
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On Peak Day Rate (pence per kWh)
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Off Peak Night Rate (pence per kWh)
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Tariff Information must be provided by the customer
Property Information
Property Information
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Property Type
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Please Specify
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Wall Type
- Cavity Wall (No Insulation)
- Cavity Wall (Insulated)
- Solid Brick
- System Built
- Metal Frame
- Other
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Floor Type
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Roof Insulation
- 0mm
- 12mm
- 25mm
- 50mm
- 70mm
- 80mm
- 100mm
- 125mm
- 150mm
- 170mm
- 200mm
- 250mm
- 270mm
- 300mm plus
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Glazing Type
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Property Age
- 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
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Heating System Required
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Electrical Supply
Thermal Value Specification
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(Figures to be obtained from Bell Design Team)
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Build Element
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External Wall - U-value (W/m2K)
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Windows - U-value (W/m2K)
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Doors - U-value (W/m2K)
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Internal Wall - U-value (W/m2K)
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Roof - U-value (W/m2K)
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Floor - U-value (W/m2K)
Property Heating System
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Main Heating Type?
- Mains Gas
- Oil
- Solid Fuel
- Electric
- Heat Pump
- LPG
- Heating not working at the time of survey
- Other
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Boiler Type
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Boiler Model
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Boiler Location
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What Location?
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New Heating Control Proposed Location
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Where?
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Photographic Evidence
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What Type
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What Type
- Old Storage Heaters
- High Heat Retention (Quantums)
- Panel Heaters
- Portable Heaters
- Other
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Heat Pump Type
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Secondary Heat source?
- 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
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Photographic Evidence
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Are we removing the secondary heat source
Existing Storage Heaters
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Possible Asbestos Containing Storage Heaters Removal Required
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Photographic Evidence
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How Many Storage Heaters/Radiators Need to be Removed in total?
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Storage Heater Serial Number (For Asbestos Purposes)
Cylinder Cupboard
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Are we proposing to change the hot water cylinder
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Cupboard Door Size
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Cupboard Depth, Width & Height
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Photographic Evidence of Cylinder Cupboard
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What Size of Cylinder Will Fit
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How will the Dischage Pipe Route to Outside be done
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Existing Cylinder Type
Room Heater Information
Rooms to install heaters
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What rooms require new heaters?
- Hallway
- Living Room
- Kitchen
- Dining Room
- Bedroom 1
- Bedroom 2
- Bedroom 3
- Bedroom 4
- Bedroom 5
- Bathroom
- W/C
- Study
- Landing
- Other
Living Room
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Dining Room
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Bedroom 1
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Bedroom 2
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Bedroom 3
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Bedroom 4
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
-
Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Bedroom 5
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Kitchen
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
-
Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Bathroom
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
W/C
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Other
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Specify Room
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Study
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
-
Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Hallway
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
Landing
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Existing Heater Type
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Heater Size
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Required Heater Type
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What Type
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Floor Level
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Will there be a heated room/space
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Floor Area (m2)
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Ceiling Height (m)
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External (Heat Loss) Wall Length (m)
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Window Area (m2)
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External Door Area (m2)
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Max Wall Space Available for Heater
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Take photo of proposed wall space
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Length (mm)
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Height (mm)
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Consider furniture, window cills, sockets etc.
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Available space must be obtained
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Any Final Comments
Declarations
Resident Declaration
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DECLARATION: I understand what what is due to be carried out and I agree to the positions of the heaters
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Customer Signature
EEM Specific Survey Information
EEM Information
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Have relevant checks been undertaken to determine if asbestos containing materials are present
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Is the nature and extent of the survey known to the customer and is it in line with their expectations
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Are the arrangements made for site access and installation materials storage adequate and appropriate for the installation to be undertaken
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The installation work will not result in non-compliance with the building regulations in relation to:
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Workmanship
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Materials
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Structural Stability
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Fire Safety
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Resistance to Moisture
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Any avoidable thermal bridging
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Any unsafe operation of combustion appliances
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Compromise the functionality of existing ventilation ducts/systems
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Compromise the functionality and/or safety of existing services (gas, electric, water, telephone, etc.)
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Any requirements stated by the supplier
Sign Off
Assessment Sign off
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Competent Person Signature and Full name
