Richard Irvin Energy Solutions

• Document No.

• Client / Site

• Address
  Address

• Conducted on

  Date

• Prepared by

• CRM Number

• Job number (warm works only)

Client Details

• Title

  Select Mr Miss Mrs Ms Dr other

  • Mr
  • Miss
  • Mrs
  • Ms
  • Dr
  • other

• If other please specify

• Forename

• Surname

• Mobile No

• Landline No

• Email

• Preferred method of contact

  Mobile

  Landline

  Email

  other

• Tenure

  Owner

  Council Tenant

  Private Tenant

  Other

• Written Permission Received

• If other please specify

Property Details

• Wall Construction

• Property Age

• Property Type

  Select Detached Semi Detached Mid Terrace End Terrace Semi Det Bungalow Det Bungalow Flat

  • Detached
  • Semi Detached
  • Mid Terrace
  • End Terrace
  • Semi Det Bungalow
  • Det Bungalow
  • Flat

• Number of Bedrooms

• Fuel Type

  Gas

  Electric

  Solid Fuel

  Oil

  LPG

• Ventilation

• DPC Level Details

• Pull Out Test (Fixings used will comply with system specification and will achieve pull test requirements. Tests will be provided but May be upon completion as tests are carried out by a third party. Please process the warrant on the basis that we will achieve the requirements).

• Access Issues

• Make and model of boiler

• Are there any CO or other safety Alarms? if so are they operational?

• Protected Species

• Front Elevation

  Media

• Rear Elevation

  Media

• Right Hand Gable

  Media

• Left Hand Gable

  Media

Install Survey

• System Specified

• Agreed Finish

• Statutory Warrants Required?

• Area to be insulated

• Percentage of area being insulated

• Overcill Colour

• Location of fire breaks

Enabling Measures

• Gas Pipe Extension

  Yes

  No

• Mains Power

  Yes

  No

• Core/Floor Vent

  Yes

  No

• Traffic Management

  Yes

  No

• Flue Extension

  Yes

  No

• Scaffolding

  Yes

  No

• BT Cable

  Yes

  No

• Sky Dish/Tv Aerial

  Yes

  No

• Outdoor Tap

  Yes

  No

• Outdoor Light Socket

  Yes

  No

• Cable TV

  Yes

  No

• Alarm Box

  Yes

  No

• Cast Pipes

  Yes

  No

• Plastic Pipes

  Yes

  No

• Soil Vents Pipes

  Yes

  No

• Gates

  Yes

  No

• Fence

  Yes

  No

• Overcills

  Yes

  No

Site Notes

• Customer Requirements, Expectation and/or Special Needs

• Variation to system required?

• Agreed Customer Attendances (Welfare, Access, Storage, Remedial Works, Neighbours Permission, Enabling works

• Additional Works Agreed by Customer

• Damage or Defects Noted at Survey Stage

• Relevant Disclaimers

• Project Specific notes

Sign Off

• By ticking this box you are confirming your acceptance of the issues, actions and spec agreed above. And For you to allow Richard Irvin Energy Solutions to carry out the Measure at no cost to you.

• You have been made aware of the scope of works to be done and have been made aware of any risks involved.

• Customer Signature

  Sign

• Surveyors Signature

  Sign

• Additional Notes