Customer Details

Ref ID

Name*

Address*

Phone*

Email*

Current EPC Rating

Look up EPC

Council Tax Rating

Look up Council Tax Rating

What 3 Words Address

https://what3words.com

Lead

Photo of Home or Building

Max. file size: 256 MB.

photo of front of home. Attached this as a small picture.

Grants & Schemes

Grant Application For GBIS Grants?*

Yes
No

Is the applicant on benefits?*

Yes
No

What benefits is the applicant on?

Type of Works

Type of Insulation work*

Cavities
Loft Insulation
Cavities & Loft Insulation
Cavity Extraction & Loft Insulation

Party Wall

Not Included.
Party Wall Only
Party Wall and Cavities

About The Building

Age of building*

New Construction
Retro fit for existing building

Type of building*

Style*

Construction*

Condition of Brick and pointing or render*

Type of Floor

Timber suspended
Solid Concrete Base
Other

How many air bricks are required?

Heating System*

Number of Bedrooms?

Number of Flats?

Is an extractor fan required for the Kitchen*

Yes
No

Is an extractor fan required for bathrooms?*

Yes
No

About the Cavity

Are Cavity Walls Showing Damp*

Yes
No

Are The Cavities Empty*

Yes
No

Is Extraction Required*

Yes
No

What Type of Insulation?*

Depth of Cavity*

Is this a Partial Fill*

No
Yes

Is a lance required

No a Lance is not required
Yes a Lance is required

Areas Requiring Insulating

Main Home or Building*

Yes
No

Does Gable Wall Top Section need insulating?*

Yes
No

Does Extension need insulating?*

Yes
No

Insulate Conservatory?*

Yes
No

Insulate Home/Garage party wall?*

Yes
No

Insulate Garage External Wall*

Yes
No

Other:

Are Cavity Barriers Required?*

Yes
No

Where?*

Semi Detached Boarders
Mid Terrance Boarders
Extensions works

Behind Tiles/Gladding with internal fill?*

Yes
No

Is there a fire place?*

Yes
No

What type of fire place?*

Open Fire Place
Log Burner
Gas Fire

What KW size is the fire place?

Does it require a core vent ?*

Yes
No
Unsure

How many fire places that require core vents?

Is there an Aga?*

Yes
No

Are remedial works required

No
Yes

Required Remedial Works

Such as anything that should be done before or after install.

Ventilation

Type of ventilation in place

Soffit vents
Tile/ ridge vents
Felt vents
Exhaust/ Flu system
Trickle vents
Cavity Vents
Bathroom Vents
Kitchen Vents
Other

Check list for cavity wall installs

Is Neighbour Access Required?*

Yes
No

Cavities have been inspected?*

Yes
No

Agreed Areas Requiring Insulation?*

Yes
No

Scaffolding Required?*

Yes
No

Has the client been told to cut back bushes climbing on walls?*

Yes
No

Has the client been told we will fit a core vent for fire places that require one?*

Yes
No

Has the client been told to fit relevant extractor fans if missing?*

Yes
No

Has the client been told to rectify any bad pointing if present?*

Yes
No

Has the client been told these will invalidate the guarantee if not completed?*

Yes
No

Is the DPC at least 150mm above ground?*

Yes
No

ALL PHOTOS BELOW ARE REQUIRED

Pleas make sure you submit photos for all the below photo requests.

Front of House

Max. file size: 256 MB.

Right of House

Max. file size: 256 MB.

Left of House

Max. file size: 256 MB.

Rear of House

Max. file size: 256 MB.

Additional External Photos

Drop files here or

Max. file size: 256 MB.

Cavity Photos

We need photos of:
• 2 scope holes per each elevation showing cavity
• Photo of the scope in each hole.
• Photos of cavity depth

Photos Showing All Elevations Cavity, Depth & Scope

Drop files here or

Max. file size: 256 MB.

General Photos

DPC

Drop files here or

Max. file size: 256 MB.

Photos of Fire Places or log burners and their KW tag

Drop files here or

Max. file size: 256 MB.

Guttering & Roofline

Drop files here or

Max. file size: 256 MB.

Photos of Boilers and external Flues positions

Drop files here or

Max. file size: 256 MB.

The position of all flues and appliances. Ventilation and extraction openings that require sleeving or safeguarding before installation

Loft gable end showing internal leaf structure

Drop files here or

Max. file size: 256 MB.

Photo of Kitchen Extraction

Drop files here or

Max. file size: 256 MB.

Photo of Bathroom Extraction

Drop files here or

Max. file size: 256 MB.

Photo of Window vents or latches

Drop files here or

Max. file size: 256 MB.

Photos Showing Air Brick Types

Drop files here or

Max. file size: 256 MB.

Floor Plans and Building Diagrams

Drop files here or

Max. file size: 256 MB.

Please draw the building plan with any conservation's including where scope holes were drilled.

Photos Showing Damp in Rooms if present.

Drop files here or

Max. file size: 256 MB.

Other Photos

Photos of required remedial works

Drop files here or

Max. file size: 256 MB.

Photos of any difficulties that the team may face.

Drop files here or

Max. file size: 256 MB.

Access & Parking Photos

Drop files here or

Max. file size: 256 MB.

Notes

Maximum distance from van to furthest section of job.

Under 45 meters
45 - 60 meters

Survey Notes

Such as anything not straight forward, like finding the place, where to park, which walls to insulate or any comments by the home owner worth knowing. Difficult access points, awkward over hangs etc.

Square Meter Measurements

Total Floor Area m2

Total Area for Extraction

Total Area for Cavity Wall Insulation

How many Rooms Require Extractor Fans?

Depth of loft insulation to be Added (mm)

Total Area for Loft Insulation

Quotation

Total Cost of Cavity Extraction

Total Cost of Cavity Wall Insulation*

Total Cost of Extractor Fans*

The Survey

Name of Surveyor

Email of surveyor

Date of Survey

Customer Surveys

Customer Details

Grants & Schemes

Type of Works

About The Building

About the Cavity

Areas Requiring Insulating

Ventilation

Check list for cavity wall installs

ALL PHOTOS BELOW ARE REQUIRED

Cavity Photos

General Photos

Other Photos

Notes

Square Meter Measurements

Quotation

The Survey