Title Page

Details

  • Client

  • Who?

  • Conducted on

  • Prepared by

  • Name of Competent Person

  • Survey Type

  • First Line of Address

  • Front Elevation Photo

  • Location
  • Project

Customer & Electrics

Customer & Electric Details

  • Current Energy Supplier

  • Which Supplier

  • Smart Meter Installed

  • Electric Meter Photographic Evidence

  • Fuse Board Photo

  • Main Fuse Cut Out Rating

  • Electricity Tariff Information

  • What is the tariff name

  • On Peak Day Rate (pence per kWh)

  • Off Peak Night Rate (pence per kWh)

  • Tariff Information must be provided by the customer

Property Information

Property Information

  • Property Type

  • Please Specify

  • Wall Type

  • Floor Type

  • Roof Insulation

  • Glazing Type

  • Property Age

  • Heating System Required

  • Electrical Supply

Thermal Value Specification

  • (Figures to be obtained from Bell Design Team)

  • Build Element

  • Are U-Values (W/m2K) known for this project

  • Figures to be confirmed by Bell Group

  • External Wall - U-value (W/m2K)

  • To be confirmed by Bell Group

  • Windows - U-value (W/m2K)

  • To be confirmed by Bell Group

  • Doors - U-value (W/m2K)

  • To be confirmed by Bell Group

  • Internal Wall - U-value (W/m2K)

  • To be confirmed by Bell Group

  • Roof - U-value (W/m2K)

  • To be confirmed by Bell Group

  • Floor - U-value (W/m2K)

  • To be confirmed by Bell Group

Property Heating System

  • Main Heating Type?

  • Boiler Type

  • Boiler Model

  • Boiler Location

  • What Location?

  • New Heating Control Proposed Location

  • Where?

  • Photographic Evidence

  • What Type

  • What Type

  • Heat Pump Type

  • Secondary Heat source?

  • Photographic Evidence

  • Are we removing the secondary heat source

Existing Storage Heaters

  • Possible Asbestos Containing Storage Heaters Removal Required

  • Photographic Evidence

  • How Many Storage Heaters/Radiators Need to be Removed in total?

  • Storage Heater Serial Number (For Asbestos Purposes)

  • Specify

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 Heater Information

Floorplan

  • Attach a Floorplan showing heaters (if required)

Heater Installation Required

  • Rooms requiring new heaters

Living Room

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Dining Room

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Bedroom 1

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Bedroom 2

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Bedroom 3

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Bedroom 4

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Bedroom 5

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Kitchen

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Bathroom

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

W/C

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Other

  • Specify Room

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Study

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Hallway

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Landing

  • Existing Heater Type

  • Model Number (if visible)

  • Required Heater Type

  • What Type

  • Floor Level

  • Will there be a heated room/space

  • Floor Area (m2)

  • Ceiling Height (m)

  • External (Heat Loss) Wall Length (m)

  • Window Area (m2)

  • External Door Area (m2)

  • Max Wall Space Available for Heater

  • Take photo of proposed wall space showing off peak switch and possible on peak cable route

  • Length (m)

  • Height (m)

  • Consider furniture, window cills, on peak sockets etc.

  • Available space must be obtained

Final Comments

  • Final Comments

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

Sign Off

Assessment Sign off

  • Competent Person Signature and Full name

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