Quantum Heating Survey V4

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

CUSTOMER NAME AND ADDRESS

• Contact:

• Address:
  Address

• Telephone:

• Email Address:

PROPERTY DESCRIPTION

• Property Type

  House

  Bungalow

  Flat

  Other

• Property Style

  Detatched

  Semi Detached

  Terraced

• Type of Construction

  Select Cavity Wall With Insulation Solid Walls Solid Floor Timber Floor Pitched Roof Flat Roof No Insulation 100mm Insulation 150mm Insulation 200mm Insulation Single Glazed Double Glazed

  • Cavity Wall
  • With Insulation
  • Solid Walls
  • Solid Floor
  • Timber Floor
  • Pitched Roof
  • Flat Roof
  • No Insulation
  • 100mm Insulation
  • 150mm Insulation
  • 200mm Insulation
  • Single Glazed
  • Double Glazed

QUANTUM HEATERS

• Would you like to measure a room?

Heater

• Room Name:

• Image of Heater

  Media

• Insert measurement of space where the heater is going (mm)

• Does the new heater require a 230v on peak supply?

  YES

  NO

• Length of New On Peak Supply (m):

• Cable Reference Method?

  CLIPPED DIRECT

  PVC TRUNKING

  CONDUIT

  CHOPPED INTO WALL

• Explain plaster damage and that a plaster will be required however this is not part of the service

• Does the heater require tall feet?

  YES

  NO

ROOM DIMENSIONS

• Area (m2)

• Floor to ceiling height

• External Wall length

• Window area (m2)

• External door area (m2)

• Internal wall length of unheated areas

• Is there a room above

  YES

  NO

  N/A

• Roof above?

  YES

  NO

  N/A

• Open fire place?

  Yes

  No

  N/A

ELECTRICAL SURVEY

• 10mm Earth to Mains Water?

  Safe

  At Risk

  N/A

• 10mm Earth to Mains Gas?

  Safe

  At Risk

  N/A

• RCD Protection on Existing House 230v Circuits?

  Safe

  At Risk

  N/A

• Image of House Fuseboard

  Media

• RCD Protection on Existing E7 Circuits?

  Safe

  At Risk

  N/A

• Image of Economy 7 Fuseboard

  Media

EXTRA WORKS - To Comply With Current Regulations:

• Are Extra Works Required?

  YES

  NO

• Main Equipotential Bonding Upgrade Required?

  YES

  NO

• New E7 Board Required?

  YES

  NO

• New On Peak Supply Fuse Board Required?

  YES

  NO

• Comments:

USEFUL INFORMATION

• Would you like to add any useful information that may assist in the installation stages?

  YES

  NO

• Comments

• Sketch

  Drawing

• Would you like to add an image?

  YES

  NO

• Image

Add Image

• Add media

  Media

EXTRA WORKS - Requested by the Occupant:

• Does the Occupant Require Additional Works?

  YES

  NO

• Insert Extra Works:

ADDITIONAL INFORMATION

• List materials required:

• Comments:

• Insert Image of Dimplex Survey Sheet

  Media

HOME OWNER SIGN OFF

• By signing this form you are confirming you are satisfied with the survey carried out. A quotation will be issued within the next 5 working days.

  Sign