ASHP Tech Survey

Customer/Property details

First Name

Last Name

Phone *

Email *

Address

Street Address

City

Postal Code

Surveyor Name

Photos of outside of property

Is asbestos suspected in present materials?

If Yes, Please detail

Electric Meter Type

Existing Heating

Stopcock Location

Photo of Stopcock

Photos of Existing Heating (Include Databadges)

Location/GPS

ASHP Details

ASHP Position

Floor Mount/Wall Mount

ASHP Photos *

Pipe Run Details from Heat Pump to cylinder *

Would you like to provide further details/photos/video of pipe route? *

notes

Additional Photos

Video if Applicable

Confirmed Clearances OK

Position Agreed with Customer

Condensate Termination

Condensate Termination Photos

Amount of Pipe Needed (15mm)In Meters

Amount of Pipe Needed (22mm)In Meters

Amount of Pipe Needed (28mm)In Meters

Amount of Talon Trunking Required (15mm) Lengths

Amount of Talon Trunking Required (22mm) Lengths

Cylinder Details

Cylinder Position

Cylinder position photos

Slim/Standard/Well Master

A/C Depth

A/C Width

A/C Height

A/C Door Height

A/C Door Width

Adequate Access to get Cylinder to Selected Location (E.G Up Stairs)

Checked Cylinder Clearances

Existing Water Supply

Cylinder Position Agreed with Customer

PRV Termination Description

Radiator Details

How many rooms require radiators?

Room 1

Room 1 Radiator Location(s)Photo(Include all Radiators)

Room 2

Room 2 Radiator Location(s)Photo(Include all Radiators)

Room 3

Room 3 Radiator Location(s)Photo(Include all Radiators)

Room 4

Room 4 Radiator Location(s)Photo(Include all Radiators)

Room 5

Room 5 Radiator Location(s)Photo(Include all Radiators)

Room 6

Room 6 Radiator Location(s)Photo(Include all Radiators)

Room 7

Room 7 Radiator Location(s)Photo(Include all Radiators)

Room 8

Room 8 Radiator Location(s)Photo(Include all Radiators)

Room 9

Room 9 Radiator Location(s)Photo(Include all Radiators)

Room 10

Room 10 radiator photos

Room 11

Room 11 Radiator Location(s)Photo(Include all Radiators)

Room 12

Room 12 Radiator Location(s)Photo(Include all Radiators)

Room 13

Room 13 Radiator Location(s)Photo(Include all Radiators)

Room 14

Room 14 Radiator Location(s)Photo(Include all Radiators)

Room 15

Room 15 Radiator Location(s)Photo(Include all Radiators)

Room 16

Room 16 Radiator Location(s)Photo(Include all Radiators)

Room 17

Room 17 Radiator Location(s)Photo(Include all Radiators)

Room 18

Room 18 Radiator Location(s)Photo(Include all Radiators)

Room 19

Room 19 Radiator Location(s)Photo(Include all Radiators)

Room 20

Room 20 Radiator Location(s)Photo(Include all Radiators)

Room 21

Room 21 Radiator Location(s)Photo(Include all Radiators)

Room 22

Room 23

Room 23 Radiator Location(s)Photo(Include all Radiators)

Room 24

Room 24 Radiator Location(s)Photo(Include all Radiators)

Room 25

Room 25 Radiator Location(s)Photo(Include all Radiators)

Additional Notes/Photos required

Additional Notes/Photos Required?

Additional Notes

Additional photos if applicable

Sign Off

Customer Pre-Requirements?(E.g. Move Furniture)

Customer Pre-Requirement Description

Confirmed with Customers that there will be some exposed pipework

Installation Notes

Surveyors Name

Customers Declaration

Following our technical survey today, would you like a follow-up call from the office to discuss any of the findings, prior to us producing a design/installation proposal?

Date/Time

Customers Name

Customer Signature

Clear

I, the surveyor,find