SGN Help for Warmth - DATA CAPTURE

• Date

  Date

• Advisors Name

  Select Chris Denman Peter Bywater Jasmine Morphew Dan Davis Johnny Fox Steve Bright Peter Tydeman Gavin Byrne

  • Chris Denman
  • Peter Bywater
  • Jasmine Morphew
  • Dan Davis
  • Johnny Fox
  • Steve Bright
  • Peter Tydeman
  • Gavin Byrne

• Client Surname

• Client Postcode

• Have you had a conversation regarding Carbon Monoxide in the Home?

  Yes

  No

  N/A

• If Yes, please completed the CO Survey - https://forms.office.com/pages/responsepage.aspx?id=vDxWuXSYq0G0SH4PYa_z65NlU0RRNaRGkIY2c6C4m99URU5ISTdNWDZFUlRJV00ySTFTUU5LRU9CTCQlQCN0PWcu&route=shorturl

  Yes

  No

  N/A

• Did you have a conversation about Carbon Monoxide and issue a leaflet?

  Yes

  No

  N/A

• Reason Why?

• Did you discuss the priority services register? www.thepsr.co.uk

  Yes

  No

  N/A

• Did you sign up the client for the Priority Services Register?

  Yes

  No

  N/A

• Reason Why?

• Does the client require a follow up call to book them in for a survey/visit?

  Yes

  No

  N/A

• What type of visit is required?

  Select SGN HV WHLG HHD Appliances

  • SGN HV
  • WHLG
  • HHD
  • Appliances

• Customer Full Name

• Tel No: (Mobile/Landline)

• E:mail Address

• First Line of Address

ADVISOR SIGNATURE

• Signed by Advisor

  Sign