The Boiler Network Sales Survey

• Address

• Customer Name

• Conducted on

  Date

• Prepared by

• Location
  Address

Job Type and Boiler information

• Job Type

  Combi to Combi

  Conventional to Conventional

  System Boiler to System Boiler

  Conventional to Combi Upgrade

  Full Heating System

• Old Boiler Make, Model & GC Number

• Old Boiler Photo

  Media

• Old Flue Type

  Room Sealed Fan Flued (4" round)

  Balanced Flue (12" Square)

  Old Chimney

  Open Flue

• Old Flue Photo

  Media

• Fuel Type

  Natural Gas

  LPG

  Biomass

  Oil

• Photo of Gas Meter

  Media

• Photo of LPG Bottles

  Media

• Photo of Pellet Store

  Media

• Photo of Oil Tank

  Media

New Boiler

• New Boiler Make and Model

  Worcester Bosch

  Ideal

  Valiant

• Model

• Boiler Location Photo

  Media

• New Flue Type

  Standard Horizontal Flue

  Vertical Flue

  Horizontal Flue Plus Extensions

• Photo of Termination

  Media

• Extra Flue Materials Needed

• Click if more than 3 extensions plus 2x 45 Bends are needed.

  Off

  On

• Flue Materials Needed?

• Plume Management Kit Needed

  Off

  On

Controls, Filter and Flush Type

• Controls

  TP ONE

  Twin Channel Programmer Plus Thermostat

  Nest + Stand

• Has Customer got WIFI

• Filter

  No Filter

  22mm Magna Clean Micro

  28mm Magna Clean Micro

  22mm Magna Clean Pro

  28mm Magna Clean Pro

• Flush Type

  Chemical Flush

  Magna Cleanse Flush

  Power Flush

• Any Thermostatic Radiator Valves Needed?

  Yes

  No

  N/A

• 8mm TRVs Needed

• 10mm TRVs Needed

• 15mm TRVs Needed

Water Flow Rates and Water Quality

• Cold Water Flow Rate @ Kitchen Tap (L)

• Cold Water Flow Rate @ Bath Tap (L)

• Cold Water Flow Rate @ Outside Tap

• Photo of Flow Rate

  Media

• Has Customer got a Water Meter

  Yes

  No

  N/A

• Is the area a hard Water area?

  Yes

  No

  N/A

• Photo of any Showers in Property

  Media

Gas

• Size of Gas Pipe at Boiler

  15mm

  22mm

  28mm

• Photo of Gas Supply to Boiler

  Media

• Is Gas Pipe Upgrade Needed

  Yes

  No

  N/A

• Length of 22mm Gas Run Needed

• Length of 28mm Gas Run

• Distance From Boiler to Gas Meter

• Rough Drawing of Gas Run

  Drawing

• Additional Gas Appliances on System

  Gas Fire

  Gas Cooker

  Water Heater

• Describe Gas Run Agreed With Customer

Condensate

• Condensate Termination

  Internal Waste

  External Waste

  Condensate Pump

• Condensate Termination for Pump

  Select 1 1/4 Waste 1 1/2 Waste 4" Soil Stack Gulley Rain Water Fall Pipe Soakaway

  • 1 1/4 Waste
  • 1 1/2 Waste
  • 4" Soil Stack
  • Gulley
  • Rain Water Fall Pipe
  • Soakaway

• External Waste Connection

  Select 1 1/4 Waste 1 1/2 Waste 4" Soil Stack Gulley Rain Water Fall Pipe Soakaway

  • 1 1/4 Waste
  • 1 1/2 Waste
  • 4" Soil Stack
  • Gulley
  • Rain Water Fall Pipe
  • Soakaway

• Internal Waste Connection

  Select 1 1/4 Waste 1 1/2 Waste 4" Soil Stack Gulley Rain Water Fall Pipe Soakaway

  • 1 1/4 Waste
  • 1 1/2 Waste
  • 4" Soil Stack
  • Gulley
  • Rain Water Fall Pipe
  • Soakaway

• Termination Photo

  Media

Cylinder and Plan

• Type of System

  S Plan

  Y Plan

  Gravity Hot Water

• Photo of Cylinder with Pump and Divertors

  Media

• New Cylinder Needed

  Yes

  No

  N/A

• Type of Cylinder

  Indirect Open Vent

  Unvented Cylinder

• Size of Cylinder Needed

• Photo of Cylinder Location Preferably with tape measure

  Media

Radiators

• Any Radiators Sold?

  Yes

  No

  N/A

• Size of Radiators and Location

• Photo of Radiator Locations

  Media

• Rough Drawing

  Drawing

Asbestos

• Is there any reasons to suspect asbestos is present within the property

  Yes

  No

  N/A

• Location of suspected substance and component

• Photo of suspected asbestos

  Media

• What is the main Type of asbestos present.

  Select AIB Lagging Cement Products Textured Coatings Gaskets/Seals Floor Coverings

  • AIB
  • Lagging
  • Cement Products
  • Textured Coatings
  • Gaskets/Seals
  • Floor Coverings

• I have been made aware of asbestos within the property, Customer Signature

  Sign

• I have made the customer aware of asbestos within the property, Surveyor Signature

  Sign

Access, Scaffold and Ladders

• Is Ladders or Scaffold Needed?

  Scaffolding Needed

  Ladders Needed

  Nothing Needed

• Photo of area that Scaffold is Needed

  Media

Brick up

• Is Brick Up Needed?

  Yes

  No

  N/A

• How many bricks Needed?

• Photo of Bricks

  Media

Payment

• Total Price on Quotation

• Amount of Deposit Paid

• Payment Method

  Cash

  Card

  Finance

• Photo of SAT note left on site

  Media

Site Notes and Additional Photos

• Site Notes

• Additional Photos

  Media

• Customer Signature

  Sign

• Engineer Signature

  Sign