CWI PIBI
Address
*
Has the Retrofit Design been reviewed before Pibi?
Yes
No
Which design document revision?
Is there an Asbestos report?
Yes
No
In the absence of the Asbestos report, what action is taken?
Exposure zone of the home
Zone 1
Zone 2
Zone 3
Zone 4
Type of Works
Type of Insulation work
*
Cavity Wall Insulation
About The Building
Type of building
*
House
Bungalow
Flat
Block of Flats
Flat above Shop
Number of Flats?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Style
*
Detached
Semi Detached
End Terrace
Mid Terrace
Maisonette
Whole Block of Flats
External Style
*
Brick
Render
Brick and Render
Stone
Metal
Timber
Pre Fab
System Built
Condition of Brick and pointing or render
*
Excellent
Good
Fair
Poor
Critical
Heating System
*
Gas
Electric
Air or Ground source Heat Pump
Oil
Is an extractor fan present in the Kitchen
*
Yes
No
Is an extractor fan present in bathrooms?
*
Yes
No
About the Cavity
Cavity Construction of original home
*
Brick and/or block
Timber Framed
Stone
System Built
Metal
Pre Fab
Are Cavity Walls Showing Damp
*
Yes
No
Depth of Cavity
*
40mm
50mm
60mm
75mm
90mm
100mm
125mm
150mm
Are The Cavities Empty
*
Yes
No
Is Extraction Required
*
Yes
No
What Type of Insulation Requires Removal?
*
Blown Fibre
White Wool
Urea-formaldehyde Foam
White Bead
Silver Bead
PIR Board
Undetermined
Is there an extension requiring CWI?
Yes
No
Cavity Construction of Extensions
*
Brick and/or block
Timber Framed
Stone
System Built
Metal
Pre Fab
Is the extension suitable for CWI?
No
Yes
Depth of Extension Cavity
*
40mm
50mm
60mm
75mm
90mm
100mm
125mm
150mm
Are The Extensions Cavities Empty
*
Yes
No
Is Extraction Required for the extentions
*
Yes
No
What Type of Insulation Requires Removal fro the extension?
*
Blown Fibre
White Wool
Urea-formaldehyde Foam
White Bead
Silver Bead
PIR Board
Undetermined
Areas Requiring Insulating
Where is CWI to be installed?
Install CWI as per Retrofit Design
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
Are Cavity Closers/Brushes Required?
*
Yes
No
Where are cavity closers Required?
*
Semi Detached Boarders
Mid Terrance Boarders
Extensions works
Wall Vents
Is there a fire place?
*
Yes
No
Does it require a passive air vent ?
*
Yes
No
Unsure
How many core vents are required?
-
1
2
3
4
5
6
7
8
9
10
Is the floor
*
Solid Floor
Suspended Floor
How many air bricks?
None Present
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
More than 20
Are there wall vents that need sealing or sleeving?
Yes
No
Square Meter Measurements
Total Wall Area
Total Outs such as windows and doors
Total Area for Extraction
Total Area for Cavity Wall Insulation
Check list
Are there any flat or fragile roof areas? e.g. conservatory
Yes
No
Is Neighbour Access Required?
Yes
No
Scaffolding Required?
Yes
No
Are there overhead power lines within 3m of the property to be treated?
Yes
No
OHPL shrouding required?
Yes
No
Retrofit Design
Cavity Insulation Materials / products to be installed
Are the products &/or system recommended in the retrofit design compliant with relevant standards?
Yes the CWI system is certificated as BAW 18-043-S-A-UK
No
Are the construction details for all affected corners, junctions and edges installation methodology available?
Yes these have been provided in the Retrofit Design
No
Third Choice
Have the testing, commissioning, handover, maintenance and guarantee requirements been provided?
Yes
no
Will the installation of the system result in unsafe operation of a combustion appliances?
Yes
No
Will the installation of the system compromise the functionality of existing ventilation ducts/systems?
Yes
No
Will the installation of the system compromise the functionality and/or safety of existing services (gas, electric, water, telephone, etc.)?
Yes
No
Will the site layout or conditions (e.g. access, party walls, adjoining properties, etc) impair the execution of the works?
Yes
No
Will the proposed installation be non-compliant with any requirements stated by the system supplier?
Yes
No
Property Suitability
Are there any structural defects, leaks or evidence of damp?
Yes
No
IF YES - Provide details and suggest an appropriate solution
Is the insulation material suitable for use in relation to wind and rain exposure?
Yes
No
Internal inspection
Do any fuse boards or meter boxes etc open to the cavity?
Yes
No
Are there gaps around any pipework (e.g. under baths or sinks) or other services which breach the cavity that require sealing?
Yes
No
Have any storage cupboards or domestic appliances been built into the cavity?
Yes
No
Do sash windows open to the cavity and are they operating properly?
Yes
No
Is internal drilling required?
Yes
No
The Survey
Where were the borescope photos taken?
Front of house
Left side wall
Right side wall
Rear wall
Extension front wall
Extension left side wall
Extension right side wall
Extension rear wall
Extension 2 front wall
Extension 2 left side wall
Extension 2 right side wall
Extension 2 rear wall
Is the type and condition of the dwelling structure suitable for the works to commence?
Yes
No
What defects prevent Install??
Access issues
Home is currently suitably insulated with EPS Bonded Bead
Current cavity wall insulation needs removing first
Timber framed home is not suitable for CWI
Timber framed extension is not suitable for CWI
Solid wall home is not suitable for CWI
Solid wall extension is not suitable for CWI
System built home is not suitable for CWI
System built extension is not suitable for CWI
Outer brick work is very poor condition in places
Pointing very poor in places
No DPC present
Sash windows open into cavity space
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.
Surveyor’s declaration : I confirm that I have surveyed the building & as far as can be determined from the visible construction & information provided that this survey is accurate for installation of Cavity Wall Insulation.
Yes
No
Name of Surveyor
Jody Paice
Matthew Owens
Andrew Woodruff
Date of Survey
DD slash MM slash YYYY
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*
Relevant Photos
External Home Photos
Cavity Related Photos
Photos of construction finish, DPC, extraction fans, window vents, heating, fire places
Hidden
Photos Showing Cavity
Drop files here or
Select files
Max. file size: 256 MB.
Hidden
External Home Photos
Drop files here or
Select files
Max. file size: 256 MB.
Hidden
Photos of construction finish, DPC, extraction fans, window vents, heating, fire places
Drop files here or
Select files
Max. file size: 256 MB.