Title Page
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Client
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What Client?
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Conducted on
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Prepared by
- Lee Glenister
- Mariusz Mikolajewski
- Simon Adolpho
- Danny Montgomery
- Chris Houghton
- Onyx Comas
- 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
Health & Safety
Health & Safety Questions
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Are you required to answer the health and safety questions
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You must complete the following questions
Access Assessment
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Do you give consent for us to carry out works within your property?
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Reasoning?
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Resident Full Name and Signature
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Is there an overhead main power cable to the property that needs sheathing before scaffold erected?
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Is a scaffold bridge required (e.g. for conservatories, out buildings attached etc.
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Are there any restrictions to the property i.e. Low bridge, neighbours access required?
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Comments
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Does the property have a main pedestrian route or a public walkway directly on one of the elevations?
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Comments
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Is there adequate parking close to the property?
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Comments
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Any parking restrictions i.e. Residents parking?
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Comments
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Will the proposed works affect neighbouring properties?
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Comments
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Photographic evidence
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Has the neighbouring property been notified of the imminent works?
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Date of notification given-
Occupant Assessment
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Is the property in a suitable condition for the proposed works to be carried out?
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Comments
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Photographic evidence
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Is the property highlighted as flagged or at risk?
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Comments
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Do the occupants have any physical disabilities that pose any significant risks?
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Comments
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Do the occupants have any learning difficulties or mental health issues where our activities may pose any significant risks?
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Comments
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Are there any potential risks regarding minors in the property?
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Comments
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Are there any potential risks regarding pets in the property?
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Comments
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Is the resident aware of any presence of protected species (e.g., bats, birds, mice) or plants that could be subject to special protection?
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Comments
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Is the property high risk of biological waste or vermin? (Add photo if required)
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Comments
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Does the resident use hypodermic needles?
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Where is the sharps bin located/comments
Asbestos Assessment
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Are we in receipt of or have access to the asbestos survey or register for this property ?
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Asbestos Assessment Needs to be Checked
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Comments
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Has asbestos been identified ?
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Comments
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Photographic evidence
Points Considered
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Use of a Step ladder/ladder
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Access and Egress
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Manual Handing
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Hand Tools/Power Tools
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Vibration
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Noise
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Dust
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House Keeping
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Lone Working
Energy Use
Electric Meter
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Has the meter information been captured on another PIBI?
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Which PIBI
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You can proceed to the next page
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Which PIBI
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You can proceed to the next page
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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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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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Is it a dual rate meter?
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Off Peak Night Rate (pence per kWh)
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Import Meter Type
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Make and Model of Meter
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What Model?
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Meter Serial Number
Ventilation
Floorplan
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Attach Floorplan showing existing and new fan locations (if relevant)
Ventilation Survey
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What rooms are present in the property
- Living Room
- Dining Room
- Kitchen
- Bathroom
- W/C
- Bedroom 1
- Bedroom 2
- Bedroom 3
- Bedroom 4
- Bedroom 5
- Utility
- Study
- Other
Living Room
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Dining Room
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Bedroom 1
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Bedroom 2
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Bedroom 3
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Bedroom 4
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Bedroom 5
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Kitchen
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Has Extractor Fan
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Extractor Fan Location
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Attach photo’s of Vent Ducting in loft (if relevant)
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Is the Extractor Fan Working
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Extractor Fan Flow Rate (l/s)
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Requirements
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Type of Extractor Fan
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Specify
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Does it Meet the Requirements
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Kitchen Extractor Fan Requires Replacement
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What size hole does the existing fan have
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Specify
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Does it Require Replacement
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What size hole does the existing fan have
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Specify
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New Extractor to be fitted
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Where could the new exactor be fitted
- Wall
- Window
- Ceiling
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Bathroom
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Has Extractor Fan
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Extractor Fan Location
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Attach photo’s of Vent Ducting in loft (if relevant)
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Is the Extractor Fan Working
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Extractor Fan Flow Rate (l/s)
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Requirements
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Type of Extractor Fan
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Specify
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Does it Meet the Requirements
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Bathroom Extractor Fan Requires Replacement
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What size hole does the existing fan have
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Specify
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Does it Require Replacement
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What size hole does the existing fan have
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Specify
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New extractor to be fitted
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Where could the new exactor be fitted
- Wall
- Window
- Ceiling
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Why?
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Specify
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Has Trickle Vents / Background Ventilation
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Why?
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Specify
W/C
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Has Extractor Fan
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Extractor Fan Location
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Attach photo’s of Vent Ducting in loft (if relevant)
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Is the Extractor Fan Working
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Extractor Fan Flow Rate (l/s)
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Requirements
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Type of Extractor Fan
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Specify
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Does it Meet the Requirements
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W/C Extractor Fan Requires Replacement
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What size hole does the existing fan have
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Specify
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Does it Require Replacement
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What size hole does the existing fan have
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Specify
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Why?
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Specify
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Has Trickle Vents / Background Ventilation
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Why?
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Specify
Other
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Specify Room
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Study
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Utility
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Has Required Door Undercuts
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Door Requires Trimming
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Has Purge Ventilation
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Has Trickle Vents / Background Ventilation
Replacement/New Fans
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Are any fans being replaced or newly fitted
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Are any ceiling fan outlets penetrating the roof
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Take photo of roof covering
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What is the roof covering type
PIV System
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Is there a Positive Input Ventilation System
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Where is it located
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Specify
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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Surveyor/Competent Person Signature and Full name