Pre-Install Survey Report

• Project Reference

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Telephone Number

1. Existing System

• Is there an existing Boiler in the property?

  Yes

  No

  N/A

• Make

• Model

• Output

• Picture of Existing Boiler

  Media

• Location of Electrical Supply

• Picture of Electrical Supply

  Media

• Location of Water Supply

• Picture of of Water Supply

  Media

2. Heat Pump

• Make

  NIBE

  Thermia

  Other

• Heat Pump Type

  Ground Source Heat Pump

  Air Source Heat Pump

• Loop Location

• Picture of Loop LactionPicture

  Media

• Chamber Location

• Picture of Chamber Location

  Media

• Header Entry Point

• Picture of Header Entry Point

  Media

• Distance to Neighbouring Boundary (m)

• Picture of Neighbouring Boundary

  Media

• Distance in front of Heat Pump (m)

• Picture in front of Heat Pump

  Media

• Is the Heat Pump Floor or Wall Mounted

  Floor Mounted

  Wall Mounted

3. Heating System

• Primary Heating System

  Radiators

  Underfloor Heating

  UFH & Radiators

  Other

  N/A
4.2. Loads lifted over persons, close proximity to obstacles incl. overhead power lines?

• Manifold Location

• Picture of Manifold Location

  Media

• Secondary Heating System

  Radiators

  Underfloor Heating

  UFH & Radiators

  Other

  N/A
4.10. SWL of plant or any lifting equipment exceeded?

• Design Flow temperature if different to Primary System (Extra Shunt Group)

• Indoor Sensor?

  Yes

  No

  N/A

• Indoor Sensor Location

• Picture of Indoor Sensor Location

  Media

• Outdoor Sensor Location

• Picture of Outdoor Sensor Location

  Media

• Cooling Required?

  Yes

  No

  N/A

• Internet Access Required?

  Yes

  No

  N/A

• Location of nearest Power supply (Plug Socket)

• Picture of nearest Power supply

  Media

• Location of nearest Internet Connection

• Picture of nearest Internet Connection

  Media

• Room Control Unit (RMU40) Required?

  Yes

  No

  N/A

• Location of Room Control Unit

• Picture of Room Control Unit Location

  Media

4. Domestic Hot Water Storage

• Hot Water Storage

  Yes

  No

  N/A
4.5. Lack of daily inspection protocol?

• Cylinder Type

  Vented

  Unvented

  Thermal Store

• Capacity (Litres)

• Cylinder Location

• Picture of Cylinder Location

  Media

5. Installation Details

• Location of Heat Pump

• Picture of Heat Pump Location

  Media

• Plant room Dimensions

• Is Pre-insulated Underground Pipe Required?

  Yes

  No

  N/A

• Location of Pre-insulated Underground Pipe

• Length of Pre-insulated Underground Pipe

• Picture of location of Pre-insulated Underground Pipe

  Media

• Is Pre-insulated Above ground Pipe Required?

  Yes

  No

  N/A

• Location of Pre-insulated Above ground Pipe

• Length of Pre-insulated Above ground Pipe

• Picture of Pre-insulated Above ground Pipe

  Media

6. Job Status

• Job Complete

  Yes

  No

  N/A

• Quote required

  Yes

  No

  N/A

• Return visit

  Yes

  No

  N/A

7. Corrective Actions

• Enter any corrective actions that will be undertaken

8. Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign