PIBI - HHRS Heater V1.0 - SafetyCulture

Title Page

Details

Client
Who?
Conducted on
Prepared by
- Callam Taylor
- Freedom Energy
- DT Electrical
- Chris Houghton
- Daniel Montgomery
- Other
Name of Competent Person
Survey Type
First Line of Address
Front Elevation Photo
Location
Project

Customer & Electrics

Customer Details

Current Energy Supplier
- Utilita
- British Gas
- EON
- EDF
- Octopus
- OVO
- nPower
- Scottish Power
- Boost
- Other
- Unknown
Which Supplier?
Smart Meter Installed?
Electric Meter Photographic Evidence
Electricity Tariff Information
What is the tariff name?
On Peak Day Rate (pence per kWh)
Off Peak Night Rate (pence per kWh)

Property Information

Property Type
Please Specify
Wall Type
- Cavity Wall (No Insulation)
- Cavity Wall (Insulated)
- Solid Brick
- System Built
- Metal Frame
- Other
Floor Type
Roof Insulation
- 0mm
- 12mm
- 25mm
- 50mm
- 70mm
- 80mm
- 100mm
- 125mm
- 150mm
- 170mm
- 200mm
- 250mm
- 270mm
- 300mm plus
Glazing Type
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
Heating System Required
Electrical Supply
Main Heating Type?
- Mains Gas
- Oil
- Solid Fuel
- Electric
- Heat Pump
- LPG
- Heating not working at the time of survey
- Other
Boiler Type
Boiler Model
Boiler Location
What Location?
Heating Controls Type
Heating Controls Location
Where
New Heating Control Proposed Location
Where?
Photographic Evidence
What Type
What Type
- Old Storage Heaters
- High Heat Retention (Quantums)
- Panel Heaters
- Portable Heaters
- Other
Heat Pump Type
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
Photographic Evidence
Are we removing the secondary heat source

Existing Heating

BBU Removal Required
Photographic Evidence
How Many Storage Heaters/Radiators Need to be Removed?
Storage Heater Serial Number (For Asbestos Purposes)
Fuse Board and Main Fuse Cut Out Rating Photo

Cylinder Cupboard

Are we proposing to change the hot water cylinder
Cupboard Door Size
Cupboard Depth, Width & Height
Photographic Evidence of Cylinder Cupboard
What Size of Cylinder Will Fit
How will the Dischage Pipe Route to Outside be done
Existing Cylinder Type

Room Information

Rooms

What rooms are present in the property
- Hallway
- Living Room
- Kitchen
- Dining Room
- Landing
- Bathroom
- Bedroom 1
- Bedroom 2
- Bedroom 3
- Bedroom 4
- Bedroom 5
- Study
- W/C
- Other

Living Room

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Dining Room

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Bedroom 1

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Bedroom 2

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Bedroom 3

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Bedroom 4

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Bedroom 5

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Kitchen

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Bathroom

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

W/C

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Other

What Room?
Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Study

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Hallway

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size

Landing

Are we replacing the heater in this room
Floor Area (m2)
Ceiling Height (m)
External Wall Length (m)
Window Area (m2)
External Door Present
External Door Area (m2)
Will there be a heated room/space
Max Space Available for Radiator (Length, Height)
Floor Level
Required Room Heater/Emitter Type
Existing Heater Present
Photo
Heater Type & Size
Any Final Comments

Resident Declaration

Declarations

Resident Declaration

DECLARATION: I understand what what is due to be carried out and I agree to the positions of the heaters
Customer Signature

EEM Specific Survey Information

EEM Information

Have relevant checks been undertaken to determine if asbestos containing materials are present
Is the nature and extent of the survey known to the customer and is it in line with their expectations
Are the arrangements made for site access and installation materials storage adequate and appropriate for the installation to be undertaken
The installation work will not result in non-compliance with the building regulations in relation to:
Workmanship
Materials
Structural Stability
Fire Safety
Resistance to Moisture
Any avoidable thermal bridging
Any unsafe operation of combustion appliances
Compromise the functionality of existing ventilation ducts/systems
Compromise the functionality and/or safety of existing services (gas, electric, water, telephone, etc.)
Any requirements stated by the supplier